Get Name And/or Address Change Form - Industrial Alliance ...

Completing the NAME AND/OR ADDRESS CHANGE FORM for Industrial Alliance is an essential step for updating your personal information. This guide provides clear, step-by-step instructions for people who need to make a name or address change efficiently online.

Follow the steps to fill out your form accurately.

1. Use the ‘Get Form’ button to access the NAME AND/OR ADDRESS CHANGE FORM and open it in your preferred editor.
2. Begin by entering your member or employee information at the top of the form: include your name as the policyholder, policy number, last name, division number, given name, member/employee ID, initials, and date of birth.
3. If requesting a name change, complete the designated section. Specify who the change is for by selecting either 'Member/Employee' or 'Spouse.' Provide the reason for the change, choosing from options such as 'Marriage,' 'Correction,' or 'Other.' If you choose 'Other,' please specify the reason.
4. In the name change section, enter your previous name as it appears on the current Group Insurance Certificate, including last name, given name, and initials. Then, provide your new name in the relevant fields.
5. For address or contact information changes, enter your previous street address, city, province, and postal code. Then, fill in your new contact details, including the new street address, email, and telephone numbers.
6. Complete any additional information if required. Ensure you have signed the section marked for the member/employee and dated it appropriately.
7. If applicable, the spouse must also sign and date the section for name change.
8. Once you have filled out all sections of the form, review for accuracy, save any changes, and choose to download, print, or share the fully completed form.

Take action today by completing your NAME AND/OR ADDRESS CHANGE FORM online to ensure your information is up to date.