Medical student - Change of address form

Formulaire - Changement d'adresse NID 487 EN

Address change

Obligatory information*

Client or identification number

Last Name *

First Name *

Date of birth *

Day

Month

Year

PREVIOUS ADDRESS

Address

Address Other (specify)...

Civic number *

Street *

Apt.

City *

Province / State *

Indicate the country if out of Canada and United States

Postal code *

Telephone *

Telephone place

NEW ADDRESS

Address

Address Other (specify)

Civic number *

Street *

Apt

City *

Province / State

Indicate the country if out of Canada and United States

Postal code *

Telephone *

Telephone place

Effective date for the change *

Day

Month

Year

Comments

Email *

Email confirmation *

I agree to receive my bills and documentation of renewal for all my insurance contracts via email

You can withdraw this consent at any time by clicking here, by calling 1 800 361–5303 or by sending a written request to the following address:

Sogemec Insurance - 2 Complexe Desjardins - PO Box 217 Stn. Desjardins - Montreal QC H5B 1G9

Today

is the ideal time for you to build your insurance capital.

It's a simple strategy that allows you to enjoy maximum protection that will evolve with you! On this level, SOGEMEC understands you best because it has been a part of FMSQ family for over 40 years. Give yourself the peace of mind offered by insurance products recommended by your Federation ... and live your life to the fullest!

I am a medical student. My place is here.

Medical student - Change of address form

Formulaire - Changement d'adresse NID 487 EN

Address change

SOGEMEC

We join forces to grow with you

Today

is the ideal time for you to build your insurance capital.

It's free!

Disability insurance coverage during your studies.