Request for Information Form

To receive information on OTIP products and services by mail, please complete the form below. All the information you provide OTIP will be treated as privileged and confidential and will be used for the purpose of providing you with the information you have requested.

If you require assistance completing this form, please contact us.

Request For Information Form

* required field

Section 1 – Contact Information
*First Name
*Last Name
*Address
*City
*Province
*Postal Code
*Home Telephone
Work Telephone
Best time to call
E-mail Address
*Are you currently retired?	YesNo
What school board are you with?
Which affiliate/federation are you a member of?
*How did you hear about OTIP?	If other, please explain:

Section 2 – Information Request
*Please send me information on the following OTIP products:	Retiree health, travel and dental insurance Life insurance Long term care insurance Occasional education employee insurance plan Critical illness insurance

Question/comment:
Characters remaining: 1,000

Please provide your estimated retirement date:
What is your family status?	Single Couple Family
What type of coverage are you interested in?	Extended health and travel Hospital Dental