Pension Plan Locator Form

At Freisenbruch we understand people change jobs, companies change pension providers and sometimes things get muddled in between, so we have created a simple online form for you to confirm whether you have a pension with Freisenbruch.

Member Information
First Name*
Middle Name
Last Name*
Date of Birth*
Month
Day
Year
Social Insurance Number*
Email*
Phone (preferred)*
Phone (alternate)
Current Residential Address*
Street Address Address Line 2 City Parish / State / Province / Region Postal Code / ZIP Country

Enter N/A under city if not applicable
Previous Address (if this may still be listed)
Street Address Address Line 2 City Parish / State / Province / Region Postal Code / ZIP Country

Enter N/A under city if not applicable
Current Employer*
Previous Employer*

(Type N/A if not applicable)
Identification
As part of the application process, you must provide a colour copy of a Government issued valid photo ID plus a photo of you holding the ID. Your face and the ID must be clearly visible in the image.
Government-issued ID*
Accepted file types: jpg, jpeg, png, bmp, gif, pdf, Max. file size: 8 MB.
Photograph of member holding ID*
Accepted file types: jpg, jpeg, png, bmp, gif, pdf, Max. file size: 8 MB.
Authorisation
I authorise Freisenbruch Insurance to confirm and verify any information provided by or about me in this form.
Member Signature*
Member Name*
Date Signed*
Month
Day
Year

Pension Plan Locator Form

Member Information

Identification

Authorisation