Address change Obligatory information* Client or identification number Last Name * First Name * Date of birth * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007 PREVIOUS ADDRESS Address OfficeHomeOther (specify)... 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 OfficeHomeOther NEW ADDRESS Address OfficeHomeOther (specify) 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 OfficeHomeOther Effective date for the change * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year202020212022202320242025 Comments Email * Email confirmation * I agree to receive my bills and documentation of renewal for all my insurance contracts via email 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
