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Fillable F37 - 20A Critical Illness - Industrial Alliance, Insurance and Financial ...

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www.inalco.com www.iapacific.com CRITICAL ILLNESS Any charges for completing this form are the responsibility of the claimant. CLAIMANT'S STATEMENT For a refund of premiums following the death of the insured, please use form F55-21A. Contract number Agent ___ Agency ___ Code ___ S.U. ___ Y M D Insured's last name___ First name ___
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