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Insurance Forms

You will find forms here for most types of coverage. If you have questions about or need assistance completing your application or making a claim, or if you need a form not listed here, we are here to help. Please contact:

Mark Venton, Insurance Coordinator, at 204−985−5846, mventon@doctorsmanitoba.ca or
Gord Brennan, Marketing Representative, at 204−985−1140, gbrennan@doctorsmantioba.ca or
Amber Pauls, Insurance Administrator at 204−985−5847, apauls@doctorsmanitoba.ca
Topher Hayward, Insurance Administrator at 204−985−5868, thayward@doctorsmanitoba.ca

Pre-Authorized Payments

Pre-Authorized Payment Application Form

Extended Health

Application for Extended Healthcare Insurance

Claim Forms

Claim form for Extended Health Benefits

Life Insurance

Application for Life Insurance

Life Insurance Assignment Form

Life Insurance Change Form

Life Insurance Non-Smoker Declaration

Claim Forms

Contact Doctors Manitoba for more information and to request a claim form.

Mark Venton
(204) 985‑5846
mventon@doctorsmanitoba.ca

Disability Income Insurance

Benefit Type

(For Student Disability and PARIM Insurance, see below)

Application for Disability Income and Office Overhead Expense Insurance

Future Insurance Option Application to Exercise FIO2

Claim Forms

Disability Insurance Childbirth Claim form

To request a claim form for Disability Income or Office Overhead Expense insurance please contact:

Mark Venton
(204) 985‑5846
mventon@doctorsmanitoba.ca

Office Overhead Expense Insurance

Application for Disability Income and Office Overhead Expense Insurance

Claim Forms

To request a claim form for Disability Income or Office Overhead Expense insurance please contact:

Mark Venton
(204) 985‑5846
mventon@doctorsmanitoba.ca

Accident Insurance

Accident Death & Dismemberment Insurance Application and Change Form

Claim Forms

To request a claim form for Disability Income or Office Overhead Expense insurance please contact:

Mark Venton
(204) 985‑5846
mventon@doctorsmanitoba.ca

Critical Illness Insurance

Critical Illness Insurance Application

Claim Forms

To request a claim form for Disability Income or Office Overhead Expense insurance please contact:

Mark Venton
(204) 985‑5846
mventon@doctorsmanitoba.ca

Student Disability Insurance

Application for Student Disability

Claim Forms

To request a claim form for Disability Income or Office Overhead Expense insurance please contact:

Mark Venton
(204) 985‑5846
mventon@doctorsmanitoba.ca

PARIM Insurance

Application for PARIM Group Insurance

Claim Forms

To request a claim form for Disability Income or Office Overhead Expense insurance please contact:

Mark Venton
(204) 985‑5846
mventon@doctorsmanitoba.ca

Last updated

April 26, 2023