Insurance Plans
Change of Beneficiary
AdvantEdge/HealthEdge Premiums
Other Administrative Forms

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)
(To obtain other forms, choose a category from the menu on the left.)

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 Services, 155 Lesmill Road, Toronto, Ontario, M3B 2T8.

If you need assistance in completing this form, contact CDSPI Insurance Services.
Change of Beneficiary Form — Life/Accident Insurance

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

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