Your contact information
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Contract No.
Title *
Ms.
Mr.
First name
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Last name
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Home address
City
Province
Postal code
Telephone (residence)
Telephone (work)
Fax
Email address
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Description of your complaint
Please identify the company
Individual Insurance
(Life insurance, disability and involuntary loss of employment insurance, accident and sickness insurance)
Savings and retirement
Investment products (RRSP, TFSA, GIC, Funds)
High-interest Savings Account
Disbursement products
Group insurance
Medical, paramedical and dental care, disability and travel
Property and casualty insurance
Property, car, recreational and leisure vehicle, legal assistance, commercial
Name of the person who processed your file
Please select the product related to your complaint
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-- Select --
Life and Health Insurance
-- Life insurance
-- Disability insurance
-- Illness insurance
Savings and Retirement
-- Investment (RRSP, TFSA, GIC)
-- Stow and Grow account
-- RRIF, LIF, Annuity
Property and Casualty Insurance
-- Automobile insurance
-- Home insurance
-- Commercial Insurance
-- Legal Access insurance
Group Insurance
Travel insurance
Others
Please describe the nature of your complaint and briefly explain the steps you took to resolve this problem. Provide specific dates and times, as well as the names of people with whom you communicated.
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What possible outcome or settlement are you expecting or would consider fair in this situation?
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Please attach any documents that may provide further details on the current situation.
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