Use the below guidelines to master all necessary requirements when filling out an enrollment form.
Please note: Enrollment forms may differ based on the product being sold.

General Information

• Our administrative office will assign the certificate number.
• The certificate owner should check the box to acknowledge their group enrollment understanding. When assigning a certificate to a funeral home, fill in all the information requested for the funeral establishment, including the Goods and Services contract number.
• All paperwork completed with applicant and/or owners must be completed face-to-face.

Instructions

1. Applicant

• The applicant is the person whose funeral is being prearranged.
• If the certificate owner is different from the applicant, the owner will receive all correspondence about the certificate.
• It’s a legal requirement to list the physical address if different from the mailing address.
• The applicant’s occupation is also required.
• The Social Insurance Number must be used as client identification on contracts that are $10,000 and over.

2. Beneficiary (for excess proceeds)

• The beneficiary should be a person or estate (next of kin or closest relative recommended).
• Include the beneficiary’s mailing and physical address(es), phone number and email address (if available).
• If a beneficiary is listed, include the relationship to the applicant.
• DO NOT name the funeral establishment as the beneficiary.
• If the beneficiary section is left blank, the beneficiary will default to the estate of the insured.

3. Preplanned Amount

• The Goods and Services total must match what’s on the Prepaid Funeral Service Agreement.
• The Total is the sum of the Goods and Services, other final expenses and Journey Home.
• SCI approval is required for a total amount greater than $25,000.
• If the total amount is $10,000 or over, obtain proper client identification.

4. Payment Selection

• Cash cannot be accepted.
• Down payment:
• Down payments are not required; however, if a client wishes to make a down payment, subtract the down payment amount from the total amount. Then multiply the remainder by the applicable Time Pay premium rate.
• Write the down payment on the Single Pay line and the Time Pay premium on the Time Pay line. Add both to indicate the proper amount of the first cheque or draft.

Example: Single Pay/Down Payment ($1,000) + Time Pay ($214.20) = Total Amount of the first cheque or draft ($1,214.20)

• Check the frequency (Monthly, Quarterly, Semi-annual or Annual) and the payment period (number of years).
• Premiums may be paid by cheque, preauthorized chequing or credit card. (Mastercard or Visa only; American Express is not accepted.)
• If the payment is by credit card, indicate the type and whether the credit card belongs to the applicant, owner or other payor. (If other payor, complete form 0058-12 OR 0058-13 depending on payment type.)
• Use the box at the bottom of the enrollment form to provide the payor’s credit card information. After sending the information to TLOC, destroy the credit card information to protect the privacy of the payor.
• If a funeral establishment cheque is used to pay the client’s premium, a photocopy of the client’s payment to the establishment must be submitted with the enrollment form.
• Cheques/money orders must be made payable to TruStage Life of Canada (TLOC). Double-endorsed cheques will not be accepted and will be returned to the funeral establishment requesting a replacement cheque.
• If PAC is selected, indicate the day future premiums are to be drafted. (First premium will be drafted immediately.)
• Indicate whether the bank account is chequing or savings.
• Attach a voided cheque to the enrollment form (if applicable).
• Subsequent credit card payments will be withdrawn on the same day of the month as the initial payment was processed.

5. Applicant Health Questions

• If the applicant answers “no” to both health questions, the plan will be FPGA Standard Issue or FPIA Preferred Issue with immediate full death benefit/full coverage.
• If the applicant answers “yes” to either of the health questions or is unable to sign the enrollment form, the plan will be Guaranteed Issue.
• The applicant is not obligated to answer any health question(s). If either question is left unanswered, the plan will be Guaranteed Issue.

6. Signature

• If the applicant is not present, there will be no signature in this section.
• Reminder: The applicant’s signature is required for a Standard/Preferred Issue Plan.
• Provide the city and date of signature.

7. Certificate Owner

• If the owner of the certificate is someone other than the applicant named, complete this section and obtain the owner’s signature.
• If different from the applicant, the owner must have insurable interest. All certificate information is sent directly to the owner.
• The funeral establishment cannot be named the owner.
• If the payor is not the applicant or the certificate owner, then complete form 0058-12 Payment Authorization OR 0058-13 Pre-Authorized Chequing depending on payment type.

8. Representative Signature and Information

• Fill out your representative information, including your TruStage ID #.