Address change Obligatory information* Client or identification number Last Name * First Name * Date of birth * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008 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 Year202120222023202420252026 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
