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Insurance Plan Application Forms

Below, you can download application forms for all insurance plans.

Simply click on the name of the insurance plan application you need from the list below. When the application has downloaded, print it, fill in the form and send it to CDSPI via regular mail or fax.

Mail completed forms to: CDSPI Insurance Advisory Services, 155 Lesmill Road, Toronto, Ontario, M3B 2T8, Fax: (416) 296-8920.

When Applying for Coverage

If you would like assistance in completing any of the applications below, contact your personal insurance planning advisor at CDSPI Advisory Services Inc. 

Insurance Plan Application Forms

For Dentists (and family members where applicable*):

Basic Life Insurance
Family Life Insurance
Combined application for Basic Life, Family Life, and Accidental Death and Dismemberment Insurance
Student Term Life Insurance
Term 100 Life Insurance
DisabilityGuard™ Insurance
Accidental Death and Dismemberment Insurance
Travel Edge Insurance*
CDSPI Retiree Benefits
TripleGuard™ Insurance (Office Insurance)
Building Insurance
Office Overhead Expense Insurance
Malpractice Insurance
Ontario Excess Malpractice
Personal Umbrella Liability Insurance*
Future Insurance Guarantee (For Long Term Disability, Office Overhead or Basic Life coverage)
Malpractice Insurance Coverage Increase
TripleGuard™ Insurance Coverage Increase

For Dental Office Staff (and family members where applicable*):

Dental Office Staff Insurance (Basic Life, Accidental Death and Dismemberment, and Long Term Disability Insurance)
Family Life Insurance
Travel Edge Insurance*
Malpractice Insurance
Personal Umbrella Liability Insurance*

Insurance Applications for Dental Students and New Dentists

Current Students

No-Cost Undergraduate Package and "Double-Up" Package Application for Students Under Age 40 (No Medical Required)

Optional Graduate Package Application for Students Under Age 40 (Medical Underwriting Required)

No-Cost Undergraduate Package and Optional Graduate Package Application for Students Ages 40 to 64 (Medical Underwriting Required)

No-Cost TripleGuardTM Insurance Activation Form

* Members of your family (anyone who is 18 years of age or older and is a spouse, common-law partner (including same sex partner), parent, grandparent, brother, sister, grandchild or in-law) can purchase these plans.

Change of Beneficiary Forms

Download the form below to request a change of beneficiary for one the following Canadian Dentists' Insurance Program plans:
• Basic Life Insurance
• Family Life Insurance
• Term 100 Life Insurance
• Accidental Death and Dismemberment Insurance
• Dental Office Staff Insurance (life and accident components)

When the form has downloaded, print it, fill in the form and send it to CDSPI via regular mail. (Your original signature is required on this form, therefore it cannot be accepted via fax.)

Mail completed form to: CDSPI Insurance Advisory Services, 155 Lesmill Road, Toronto, Ontario, M3B 2T8.

If you need assistance in completing this form, contact CDSPI Insurance Advisory Services.

Change of Beneficiary Form — Life/Accident Insurance

Applications for AdvantEdge/HealthEdge Rates

Below, you can download the application form to apply for AdvantEdge or AdvantEdge Special rates under the Canadian Dentists' Insurance Program’s Basic Life Insurance or Family Life Insurance plans.

The same application can be used to apply for HealthEdge rates under the Insurance Program’s Long Term Disability Insurance or Office Overhead Expense Insurance plans.

Mail or fax the completed application form to:
CDSPI Insurance Advisory Services, 155 Lesmill Road, Toronto, Ontario, M3B 2T8.  Fax: 416-296-8920.
If you need assistance completing this form, contact CDSPI Insurance Advisory Services.

Application: AdvantEdge/AdvantEdge Special Rates for Basic Life or Family Life Insurance; or HealthEdge Rates for Long Term Disability or Office Overhead Expense Insurance

Other Administrative Forms

Below, you can download administrative forms for certain Canadian Dentists’ Insurance Program plans. 

Simply click on the name of the form you need from the list below. When the form has downloaded, print it, fill in the form and send it to CDSPI via regular mail.

Mail completed forms to: CDSPI Insurance Advisory Services, 155 Lesmill Road, Toronto, Ontario, M3B 2T8.

If you need assistance completing a form, contact CDSPI Insurance Advisory Services.

Pre-Authorized Chequing Plan
Pre-Authorized Credit Card Plan
Lost Policy Form
Assignment/Ownership Form
Application for Non-Smoker Rates*

* For the Basic Life, Family Life, Term 100, Long Term Disability, Office Overhead Expense or Dental Office Staff Insurance plans.

Note: To view these forms, you will need to have Adobe Acrobat Reader installed on your computer.