Corporate Benefits Division



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The Next Step

START YOUR PERFECT PLAN TODAY
Benefit Options
Life Insurance:
Accidental Life and Dismemberment:
Extended Health Care:
Vision Care:
Dental Care:
Short Term Disability:
Long Term Disability:
Critical Illness:
Company Information
Number of Employees:
Will all eligible employees participate in the plan?
Does your company currently have employee benefits?
Name of Carrier
Renewal Date (e.g. 01/24/09):
Are your employees covered under workers compensation?
Are any employees absent from work due to disability, maternity or leave of absence?
Cost sharing arrangement between employer/employee?		Employer Employee

Company Name:
Contact Name:	*
Job Title:
Address:
City:
Postal Code:
Province:
Contact Telephone:	*
Contact Fax:
Contact Email:	*
Type of Business:
Number of Years in Business:
Website:
Comments:

Please note that the data fields highlighted with * are mandatory. All other fields are not mandatory, however the more information that is provided the easier it will be to start designing your Perfect Plan. Once the information is submitted a Corporate Benefits Division solutions specialist will contact you to complete the process of designing your Perfect Plan.

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