Beneficiary Designation Form

Use this form:

  • To designate your beneficiaries for Basic Life/Accidental Death, and/or Optional Life/Optional Accidental Death insurance
  • At time of initial enrolment if you want to designate more than 3 primary beneficiaries
  • To change your existing beneficiary(ies). The beneficiary(ies) listed here will replace your previous beneficiary designation

Hour Bank Plan – Click here to download the Beneficiary Designation form. 

Office Plan – Click here to download the Beneficiary Designation form.

  • Please rename the file to include your Company Name prior to uploading (eg: CompanyName-PAD-Form.pdf).

Already enrolled on an MCIP plan? Add your dependents to your plan.

Click here for the Hour Bank Plan.

Or click here for the Office Plan.

Hour Bank employees, upload your Beneficiary Designation form below.

Office Plan employees, upload your Beneficiary Designation form below.

How do I know my upload was successful?

Look for ‘SUCCESS‘ next to your upload. An example is highlighted in the image below: