Accident insurance (Accirance) application – Instructions

Note
As your application cannot be saved, please print a copy for your files before submitting it.

Make applying online easy

Time required to fill out the application:
Between 10 and 15 minutes. (For security purposes, your application form will be automatically terminated after 30 minutes of inactivity.)
Application processing time:
A Desjardins advisor will follow up within 24 hours (business days) of receiving your form to finalize the application.
Information to provide:
  • First name, last name, gender and age of the person or persons to be covered.
  • Financial institution contact information (institution and transit numbers).
  • The credit card number or account number you will use to make your payment.

Continue your accident insurance application

Guaranteed 100% Secure program

Please note that all our forms are secure and that the personal information you send is used only for the purpose of responding to your application. To find out more about privacy and security.

For assistance completing the application, please contact Desjardins Financial Security at 1-877-270-7721, Monday to Friday, 8 a.m. to 5 p.m. (EST).