1.  Employer Completes and Signs:

          a. Master Application (PDF)

          b. calculate and print your quotation (calculate rate) 

          c.  Bank Pre Authorization (PDF) attach a Void Cheque

          d.  print and complete two Disclosure Statements (PDF) 

     2.    Each Employee Completes and Signs:

          a.  Enrollment/Change form  (PDF) 

          b.  Group Health Evidence (PDF)

.         c.  Personal  Authorization giving us permission to speak with their spouse (PDF), or friend

          d.  Have signatures witnessed where required.

               If you require assistance phone Bruce or Sandy at 1-866-861-1006 (Contact Us)

               Keep a copy of all documents for your records !

     3.   What to Send

          a. fully completed Original applications,

          b. signed Bank Pre-Authorization, Void Cheque 

          c.  a cheque made payable to ICBA Benefits for the 1st months premium

          d.  a signed copy of the Disclosure Statement

          e.  send  your documents to:

 Bruce A. Hollett & Associates
#401-1630 Pandosy Street
Kelowna B.C. V1Y 1P7  

          What we do:

           a.  notify you when we receive your forms 

           b.  review the forms, contact you to obtain missing information

           c. once the insurance company has reviewed your medical information we will advise you of
               their decision and plan effective date. 

           d. booklets and plan administration kit will be sent by Canada Post in about 30 days from the time
               the application has been received at the insurance company.

           e. if your application has been declined you will receive a full refund   

            f. we are available to answer questions and offer assistance as required  (contact us)

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