At Your Service: Request a Change
Payment Method Change

For your convenience you can submit your change of contact information to Manulife Financial online.



If you prefer, you can instead print this form, write in your information below, and mail it to:
    Manulife Financial
    Affinity Markets
    P.O. Box 4213, Station A
    Toronto, ON, M5W 5M3

To ensure that we have enough information to process your request, please complete ALL of the following:

Tell Us Who You Are:
* Required field


* Your Policy/Certificate Number
(10 digits)
* Your First Name (as shown on your Policy)
* Your Last Name (as shown on your Policy)
* Your Date of Birth / / 19 (yy)

Address Information
* Required field


* Country
* Address 1
Address 2
Address 3
* City/Town
* Province/State
* Postal/Zip Code
* Residence Telephone( ) -
Business Telephone ( ) - ext
E-mail Address

Select the Payment Method You Want*
* Required field


(Note: Your future Premium Notices will automatically reflect your most current choice of payment method.)

Monthly Payment:

Monthly by Credit Card
Credit Card NumberExpiry Date
/
For your convenience, if you choose payment by credit card, your future premium billings will automatically be charged to your card each month.

Monthly by Pre-Authorized Debit from My Chequing Account

Change My Current Chequing Account Information.
Transit NumberBank NumberAccount Number

Annual Payment:
Annually by Credit Card
Credit Card NumberExpiry Date
/
For your convenience, if you choose payment by credit card, your future premium billings will automatically be charged to your card each year.

Annually by Cheque
Your future billing will automatically reflect your most recently requested payment method.

Please check and correct your information above, and then click on "Continue". You will then be presented with a summary of the information you have sent. Please print the summary and keep for your records.