POLICY LOAN HISTORY OR POLICY PREMIUM HISTORY REQUEST
Head Office
One Westmount Road North
P.O. Box 1603 Stn. Waterloo, Waterloo, Ontario N2J 4C7
TF 1.80 0. 722.6615 T 519.886.5210
www.equitable.ca
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
46(2020/06/30)
Policy Number: Policyowner(s):
£ The undersigned requests The Equitable Life Insurance Company of Canada to provide a loan history for the above policy number.
OR
£ The undersigned requests The Equitable Life Insurance Company of Canada to provide a premium history for the above policy number.
I request the history as follows:
£ Maximum history available (7 years) £ From dates , 20 to , 20 .
Signature of Policyowner Signature of Policyowner
Date Witness to all Signatures
Fees as follows must be attached to request. Please make cheque payable to Equitable Life of Canada.
History under 2 yrs (no charge) History for 2 to 5 yrs – $50* History 5 to 7 yrs – $100* *Please note histories more than 2 years may require additional processing time.
Please note: Equitable Life
®
cannot ensure the privacy and confidentiality of any information sent through the internet because e-mail may be vulnerable to interception. As a result, Equitable Life is not
responsible for any loss or damages you may incur if your information is intercepted and misused. If you would prefer to submit your information by another means, please contact us at 1.800.722.6615.
