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.

Keep in mind
  • An incomplete request will take longer to process.
  • Your request may take up to 30 days to process.
  • A secure system is used to send you information.

Your contact details

Your request

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.

Indicate the period corresponding to the information you need:

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?