Application To Group Insurance Form Page 2
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1
2N O T I C E
La Capitale Insurance and Financial Services Inc. (hereafter La Capitale), wishes to advise you that
information collected during this transaction will be kept in a file under the subject of “Group Insurance”.
Access to this file is restricted to employees and agents of the company, on a need-to-know basis, as
required to fulfil their duties or carry out their assignments. Notwithstanding exceptions provided for by
law, no other person may access your file without your authorization. Your file will be kept at the address
below.
You may access your file by submitting a request in writing to the information Access Officer in the
Administration Department. If any of your personal information is inaccurate, incorrect or incomplete,
you may submit a request in writing to have it corrected.
When you take out a contract with La Capitale, your name and address are included in our client database
to help us provide you with quality service and information on new products designed to meet your
needs. If you would prefer to have your contact details removed from our distribution list, please call or
write to let us know.
La Capitale Insurance and Financial Services Inc.
625 Saint-Amable St.
P.O. Box 1500
Quebec QC G1K 8X9
Customer Service
Telephone: 418 644-4200
or
Toll free: 1 800 463-4856
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