Form - Protection of your personal information

Simply fill out this short form to access your personal information, change it or make another request. Our team will be in touch with you as soon as possible.

Select the nature of your request:
This may include your health details, personal information provided when buying your insurance, or information about your claims or benefits.
This will help us to better answer your request.
This may include your health details, personal information provided when buying your insurance, or information about your claims or benefits.
Who are you making this request for?
This number contains 9 to 10 characters
This number contains 9 to 10 characters
File formats accepted: .doc, .docx, .pdf, .xls, .xlsx, .txt, .rtf, .jpg, .gif, .et, and .png.
Maximum attachment size: 10 MB
Number, street, city, province, postal code
Which Beneva product(s) do you have?