Address change Obligatory information* Client or identification number Last Name * First Name * Date of birth * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006 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 Year201920202021202220232024 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
