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          ivari
          P.O. Box 4241, Station A
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        • Financial quick links
          • Fund facts & performance updates
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          • Fund code finder
          • Segregated fund financial statements
  • About ivari
        • Contact
        • Main reception
          416-883-5000

          Corporate mailing address
          ivari
          200-5000 Yonge Street
          Toronto, Ontario M2N 7E9
        • Policy-related contact
        • Are you a policyholder with ivari?
          Please use this mailing address for all policy-related correspondence

          Policy-related mailing address
          ivari
          P.O. Box 4241, Station A
          Toronto, ON M5W 5R3
        • Customer service
        • Toll free: 1-800-846-5970

          For general inquiries:
          [email protected]

          Need to send us something?
          Send requests securely
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Forms & guides

Looking for an ivari form? Need product guides or other reference information? You can find it here.

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Frequently used forms

Here are quick links to our most commonly downloaded material.

We recommend that you download/save our PDF forms to your device and use Adobe Reader to complete and save them. By default, your device may open PDF files in your web browser.

Using a browser to complete form fields can cause unexpected results or loss of inputted information. If you do not have Adobe Reader, you can download the latest version for free from https://get.adobe.com/reader/otherversions.

  • Policy Service Application – PS339 NEW
  • Change of Beneficiary Form – PS367 NEW
  • Pre-Authorized Debit (PAD) for Insurance Products – PS375 NEW
  • Insurance Application – LP257* NEW
  • Policy Change Application – LP386* NEW
  • Identity and Third Party Determination – IP-LP782 NEW
  • Request for Change of Servicing Representative – DCC369 NEW
  • Notice of Transfer of Ownership for Insurance Products – PS371 NEW
  • Conversion Application – LP1285 NEW
  • Allocation Form – PS425 NEW
  • Financial Service Form – IP416 NEW
  • Contact Information Change – IV1527 NEW
  • Policy Ownership for Corporate & Non-corporate entities or Trusts – IP-LP1747 NEW
  • Universal Life Fund Code Chart – LP946
  • Life Insurance Products & Critical Illness Protection Riders – LP2027
  • Politically Exposed Persons and Head of International Organization – IP-LP1165 NEW
  • Claimant’s Statement for Life Insurance Claims – CL213 NEW

* The fillable life application is for one life, with the option for multiple coverages. If you need to add additional lives, or is a joint plan, we recommend using our e-Application ivari 360.

Find…Complete…Sign…and Send!

After completing and signing your form, upload it securely to ivari through our Send documents tool on the Send requests page. To avoid delays in processing your request, the signature on the form must be comparable to what ivari has on file.

Search for a form

Title Form number Additional information Link
“In Good Order” (IGO) Transaction Guidelines – Investment Products Operations Administrative Guide IP59

A login is required to download this file.

Download
“In Good Order” (IGO) Transaction Guidelines – Life Operations Administrative Guide LP1352

A login is required to download this file.

Download
“In Good Order” (IGO) Transaction Guidelines for WFG – Life Operations Administrative Guide WFG-LP2152

A login is required to download this file.

Download
Activities (Ongoing) Questionnaire CL2141 Download
Activities Questionnaire CL2140 Download
Advisor Screening Questionnaire DCC1698 Download
Affidavit IV1783 Download
Alcohol Usage Questionnaire UW-ALCQ377 Download
Allocation Form PS425 Download
Amendment between ivari and Broker DCC546

A login is required to download this file.

Download
Application to Exercise Purchase Option Rider PC1771 Download
Assignment DCC853

A login is required to download this file.

Download
Attending Physician’s Statement of Continuing Disability CL1676 Download
Aviation/Ultralight/Ballooning/Hang Gliding Questionnaire UW-AVIQ312 Download
Broker’s Contract DCC521

A login is required to download this file.

Download
Broker’s Contracting Kit DCC1514

A login is required to download this file.

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Certificate of Incumbency IP-LP1572 Download
Certificate of Incumbency – Fillable form DCC1137

A login is required to download this file.

Download
Change of Beneficiary Form PS367 Download
Claimant’s Statement (for Investment Products) CL766 Download
Claimant’s Statement (Life Insurance Claim) CL213 Download
Code of Ethical Market Conduct DCC1388

A login is required to download this file.

Download
Collateral Assignment PS391 Download
Compassionate Assistance Program – Attending Physician’s Statement CL1724 Download
Confidential Business Financial Questionnaire UW-BFINQ361 Download
Confidential Personal Financial Questionnaire UW-PFINQ362 Download
Confirmation of Compliance by Financial Institution Locked-in Pension Funds IP533 Download
Contact Information Change IV1527

Complete and submit online.

Download
Contingent Owner PS373 Download
Contract Requirements and/or Transfer Request DCC358

A login is required to download this file.

Download
Conversion Application LP1285 Download
Convert a Registered Retirement Income Fund (RRIF) to a Registered Retirement Savings Plan (RRSP) IP1119 Download
Corporate/Non-Corporate Entity/Trust Ownership IP-LP1166 Download
Critical Illness Attending Physician’s Statement CL1476 Download
Critical Illness Claimant’s Statement CL1477 Download
CriticalADVANTAGE Claimant’s Statement CL1007 Download
Dealer/Nominee Transfer Form IP1186

Use this form to transfer from:

  • Dealer/Nominee to Dealer/Nominee
  • Nominee-Name to Client-Name
  • Client-Name to Nominee-Name
Download
Declaration of tax residency for an entity IP-LP1601 Download
Direct Deposit Information DCC290 Download
Drug usage questionnaire UW-DRUGQ378 Download
Education, Training and Experience Questionnaire CL2142 Download
Electronic Funds Transfer (EFT) for express invoice payment CL2139 Download
Employer’s Statement Questionnaire CL2143 Download
Financial Service Form IP416 Download
Five for Life Fund Code Chart IP1348 Download
Foreign Death Questionnaire CL1720 Download
Foreign Travel Questionnaire UW-FTQ399 Download
GROWSafe (GS) / GROWSafe2 (GS2) Fund Code Chart IP1372 Download
GROWSafe3 (GS3) Fund Code Chart IP653 Download
Identity and Third Party Determination IP-LP782 Download
imaxx Guaranteed Investment Funds Application IP881 Download
imaxx Guaranteed Investment Funds Information Folder IP882

This Information Folder is not complete without the Fund Facts.

Download
imaxxGIF Fund Code Chart IP884 Download
Information organizer LP1750

Here…there…and everywhere!

That’s how many people file their personal and financial information. This can become an issue if an emergency situation arises and you, or someone you trust, has to find and use this information.

You can take charge today and ensure that all of your important personal, medical and financial information is located safely, securely and up-to-date should it need to be accessed.

Download
Initial Attending Physician’s Statement CL1008 Download
Insurance Application LP257

Use this application when applying for:

  • All life insurance and critical illness products
  • All replacements of insurance contracts

The fillable life application is for one life, with the option for multiple coverages. If you need to add additional lives, or is a joint plan, we recommend using our e-Application ivari 360.

Download
Insured’s Request for Living Benefits CL1725 Download
Insured’s Request for Compassionate Assistance Benefit CL2111 Download
Insured’s Statement for Disability and Waiver Claim CL1009 Download
Investment Managers Series (IMS) III Fund Base Guarantee* form IP1292

*IMS III policies issued on or after February 3rd, 1998

Download
Investment Objectives & Segregated Fund Options IP1478 Download
Investor profile questionnaire LP1402

ivari Universal Life Investor profile questionnaire

Download
Investor profile questionnaire – WFG advisors WFG-LP1222 Download
ivari Guaranteed Investment Funds – Fund code chart IP1347 Download
ivari’s non face-to-face application guidelines IV1616 Download
ivari’s non-face-to-face insurance application guidelines – WFG advisors WFG2012 Download
ivari’s Underwriting Requirements – Life Insurance Products & Critical Illness Protection Riders LP2027 Download
ivari’s Underwriting Requirements Chart for Life Policy Changes LP1416

For advisor use.

Download
Job Analysis CL1464 Download
Limited Power of Attorney – ivari Investment Product Contracts IP177 Download
Limited Power of Attorney – Life Products LP183 Download
Managing Broker’s Contracting Kit DCC1515

A login is required to download this file.

Download
Market Intermediary Agreement DCC522

A login is required to download this file.

Download
Market Intermediary Agreement (MIA) Kit DCC1513

A login is required to download this file.

Download
Martial Arts & Combat Sports Questionnaire UW-MARTSQ1880 Download
Medical Authorization UW-LP1094 Download
Motor Vehicle Authorization (Alberta) MVR-AB

Note: Some browsers such as Chrome and Firefox use their own PDF viewers, which is incompatible with this form. If you are unable to view the form, please save the form to your computer’s hard drive and open it using Adobe Reader.

Download
Motor Vehicle Authorization Form (British Columbia) MVR-BC Download
Motor Vehicle Authorization Form (Manitoba) MVR-MB Download
Motor Vehicle Authorization Form (Northwest Territories) MVR-NT Download
Motor Vehicle Authorization Form (Quebec) MVR-QC Download
Motor Vehicle Authorization Form (Saskatchewan) MVR-SK Download
Motor Vehicle Authorization Form (Yukon) MVR-YT Download
Motor Vehicle Authorization Form & Letter (Nunavut) MVR-NV Download
Motorized Vehicle Questionnaire UW-DRIVQ379 Download
Motorized Vehicle Racing Questionnaire UW-RACEQ401 Download
Mountaineering Questionnaire UW-MTNQ398 Download
Nervous Disorder Questionnaire UW-NERVQ346 Download
NN IP Segregated Funds Products Fund Code Chart IP1373 Download
Non-Financial Service Form for Existing Clients Only IP426 Download
Notice of Cancellation Movable Hypothec without Delivery (Québec) PS2137 Download
Notice of Movable Hypothec without Delivery (Québec) PS1462 Download
Notice of Transfer of Ownership for Insurance Products PS371 Download
Overhead Expense Application Supplement Download PC1772 Download
Parachuting/Sky Diving Questionnaire UW-PARAQ394 Download
Paramedical Examination Report UW-LP40 Download
Physician’s Statement Proof of Death CL990 Download
Plan Type Registration Change IP421 Download
Policy Change Application LP386 Download
Policy Ownership for Corporate & Non-Corporate Entities or Trusts IP-LP1747 Download
Policy Service Application PS339

Policy Service Application

Download
Politically Exposed Persons and Head of International Organization IP-LP1165 Download
Politically Exposed Persons and Head of International Organization for Claims – For beneficiary use only CL2110 Download
Pre-Authorized Debit (PAD) for Insurance Products PS375 Download
Pre-Disability Self Employed Profile CL1465 Download
prosperity term Rate Guide – for WFG WFG-LP1296 Download
prosperity Universal Life Fund Code Chart – WFG advisors WFG-LP1779 Download
Questions to be Posed when a Spouse Claims as Beneficiary CL580 Download
Reinstatement and non-smoker change application for Simplified and Guaranteed Issue policy LP1990

A login is required to download this file.

Download
Release of Collateral Assignment PS2136 Download
Request for Change of Servicing Representative DCC369 Download
Request for Registration as a RRSP PS341 Download
Residual Income Loss – Current Earnings Statement CL383 Download
Residual Income Loss Prior Earnings Statement CL356 Download
Respiratory (Asthma) Questionnaire UW-RESPQ347 Download
Scuba Diving Questionnaire UW-SCUQ395 Download
Segregated Funds Products Fund Code Chart IP1490 Download
Seizure Questionnaire UW-SEIZQ349 Download
Simply Simplified Issue and Simply Guaranteed Issue Product Guide LP2202

The intent of this guide is to provide you with detailed information about Simply Simplified Issue and Simply Guaranteed Issue products and their features.

Download
Single Premium Immediate Annuity (SPIA) Application IP-NB151 Download
Smoking and/or Tobacco Questionnaire UW-SMOKQ376 Download
Statement of Persons Insured under Family Insurance Rider CL578 Download
Summary of ivari’s segregated funds IP1371 Download
Supplemental Health Questionnaire for the Insurance Application LP-HS2126 Download
Supplementary Statement of Disability CL335 Download
Termination of Assignment DCC854

A login is required to download this file.

Download
TermSelect Rate Guide LP471 Download
Transfer from a Registered Qualified Policy to an imaxxGIF Contract IP1212

IMS I, II, III or GROWSafe 94 segregated fund contracts

Download
Transfer from a Registered Qualified Policy to an imaxxGIF Contract – Electronic Kit IP903T Download
Transfer from a Registered Qualified Policy to an ImaxxGIF Contract – Product Comparison Chart IP1281 Download
Transfer of Ownership – Investment products IP1270 Download
Unclaimed Property Request LP-IP1451 Download
Underwriting Height and Weight Chart LP1403 Download
Underwriting requirements chart for Critical Illness policy changes LP1662

For advisor use.

Download
Universal Life Fund Code Chart LP946

Fund codes and available interest options by plan for ivari Universal, EstateAdvantage, WealthAdvantage, AdvantageLife, AdvantageLifePLUS, Assured Life, Transaver, Tplan and Lifetime Saver plans (for use with PS425 – Allocation Form)

Download
Valid industries and occupations IP-LP1971

Use this form to determine the valid industries and occupations when employment or industry information is required on an ivari form/ application.

Download
Variable Investment Options (VIO) & General Interest Options (GIO) Universal Life Fund Code Chart LP946C

Fund codes and available interest options by plan for Challenger, Discovery 2000, ACHIEVER, ENDEAVOUR, HORIZON and OMNILIFE plans (for use with PS425 – Allocation Form).

Download

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e-Signature guidelines

The e-signature guidelines have been moved to this page.

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P.O. Box 4241, Station A
Toronto, ON M5W 5R3

416-883-5000 . Telephone
1-800-846-5970 . Toll free
[email protected]

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ivari is a member of Assuris. Assuris is the not for profit organization that protects Canadian policyholders in the unlikely event that their life and health insurance company fails. Details about Assuris protection are available at www.assuris.ca.

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