Download and Print an Enrollment Form

(Adobe Acrobat Reader is required. Click here to download.)

• Mail your application and Cheque or Money Order payment to:
  
  Reliable Life Insurance Company
  Student Accident Insurance
  Box 557, 100 King Street West
  Hamilton, Ontario
  L8N 3K9
  
  
• You may also fax your application (be sure to include your credit card number on the form) to 905-528-8338

Prefer to have an application mailed to you?

To have your Student Accident Insurance application(s) mailed to you, please contact:

Reliable Life Insurance Company
Student Accident Insurance
Toll Free: (800) 463-5437

We're looking forward to hearing from you!