Application Enrolment Forms

The following forms allow you to enrol your employees for RBC Insurance group life, health or dental insurance as well as manage your insurance policies:

Administrative Services Only (ASO) - Self-Insured STD Benefit 
Employers need to fill out this form to apply for group ASO benefits.
Form Number: 13035-1

Beneficiary Designation Card 
Employees purchasing life insurance are required to provide RBC Insurance with a beneficiary designation card to keep on file with the insurance plan. This is only necessary if you have not completed an Enrollment Card.
Form Number: 13049

Client Information Questionnaire 
Employers need to fill out this form to apply for group insurance for their company. It will document administrative requests surrounding your plan.
Form Number: 83604

Confirmation of Appointment of Third Party Administrator (TPA) 
As a policyholder, if you are appointing a TPA you must fill out this form with the TPA's name, policy number, and other relevant information.
Form Number: 13033B

Election of Portability Coverage - Voluntary Group Term Life Insurance 
If an employee has recently been terminated, they may be eligible to apply for conversion and become insured under the Group Voluntary Life Portability Policy. Learn about this benefit and how to apply.
Form Number: 13094

Employee Data Listing 
A grid that plan administrators can use to submit employee information at time of issue or renewal
Form Number: 13082

Evidence of Insurability Form 
Both the employee and the plan administrator must fill out this approval form for reasons specified within the insurance contract(s).
Form Number: 13074

Group Enrollment Card 
To enrol in group insurance, the employee and employer must fill out this card and return it to RBC Insurance.
Form Number: 13006

Group LTD Conversion Facts 
If your plan has a conversion option and an employee who has been covered for long term disability benefits under a group long term disability plan for at least 12 months, has recently terminated employment, that employee may be eligible to apply for conversion and become insured under the Group LTD Conversion Policy. Learn about its benefits and how to apply.
Form Number: 13079-1

Group Request for Change 
Both the employer and the employee must complete this form if the employee's name has changed, they wish to change their beneficiary information, or the number of dependents has changed. If adding a dependent through marriage or birth, we must receive this form within 31 days of the event.
Form Number: 13017

Life Conversion Application 
If an employee has recently been terminated or their life coverage was reduced, they may be eligible to apply for conversion and become insured under the Group Life Conversion Policy. Learn about its benefits and how to apply.
Form Number: 13086

Refusal of Coverage Form 
Both the employer and employee must complete this form if the employee does not wish to enrol in short and/or long term disability coverage offered under their employer's non-mandatory plan.
Form Number: 13026

Social Insurance Number Authorization Card 
If the employer chooses to use social insurance numbers for identification purposes, employees must provide us with authorization to use their social insurance number and keep it on file as part of the insurance plan.
Form Number: 13066

Trustee Designation Card 
Employees must fill out and sign this card in order to appoint a trustee for a minor beneficiary.
Form Number: 13090B

Voluntary Accident Insurance Enrollment Form 
To enrol in group voluntary AD&D insurance, the employee and employer must complete this card and return it to RBC Insurance.
Form Number: 20103

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