Cancellation of Living
Benets Policy
Policy Number Insured
A Please cancel my policy
Disability Policy Critical Illness Policy
B Policy owner’s information
Name of Policy Owner
(Please Print)
Street Address
City Province Postal Code
(Please Print)
C I agree to the cancellation of coverage requested in this form
Once my policy is cancelled, I understand that insurance coverage will no longer be provided under this policy and
reinstatement will not be available.
Any corrections to this form must be initialed by all signing parties.
Policy Owner’s name
(Please Print)
Date (dd/mm/yy) Policy Owner’s signature
Irrevocable Beneciary’s name, if applicable
(Please Print)
Date (dd/mm/yy) Irrevocable Beneciary’s signature
Cancellation will be processed on the monthiversary after this form is received in our ofce.
We will process a refund for any premiums paid beyond the next monthiversary after this form is received. This will be
refunded via Electronic Funds Transfer to the account we are currently withdrawing premiums from.
Submit by FAX at 905-813-4816 or 1-888-881-7712
Submit by MAIL to RBC Life Insurance Company, Client Services, P.O. Box 515, Station A, Mississauga ON L5A 4M3
Submit by email to indcancustomerservic@rbc.com
click to sign
signature
click to edit
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click to sign
signature
click to edit
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