Changing Beneficiary, Name, Address, Employment Status, Or Birth Date (Correction)
Plan Administrator completes Section 1 of the Change Form by indicating the Plan Member's , name, effective date of change etc.
Plan Member completes section 12 and signs the Change Form
Correction to date of birth is accepted only with accompanied proof of age documentation
For Beneficiary Changes, the Plan Member must sign and date the form to validate the change – keep this original form in the Plan Member’s personnel file. In the event of a claim, the original form is required by the insurance carrier.
895 Don Mills Road, CPAG
Toronto ON M3C 1W3
Fax to 1.877.464.0109; or
Scan and email to firstname.lastname@example.org
Note: It is important to keep a Plan Member’s beneficiary designation up-to-date
as the insurance carrier will pay life benefit proceeds to the last named beneficiary
only (as indicated on the employee’s original signed Enrolment or Notice
of Change Form.