I understand that Doctors of BC will use this form to increase my existing Disability Insurance and that the additional coverage will be effective on, the later of, the date the Association receives the application or July 1, 2022.
I understand that if I cancel any of my insurance programs and reapply at a later date, coverage will not be automatic and I will be required to provide medical evidence of my health at that time.
Electronic Signature Authorization
By signing below, you are confirming that you are the member named in this form and you acknowledge that you are signing this document electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this document.