Beneficiaries or estate representatives claiming workplace group life benefits from Canada Life sometimes need the attending physician to complete this one-page certificate. It certifies the date and the chief and contributing causes of death, when the illness was diagnosed and when it became severe enough to stop the person working, the manner of death and the person's smoking history.
The attending physician completes the entire certificate, which states it should be completed in full by the Attending Physician, and signs it with name, address and telephone. The beneficiary or estate representative completes the workplace life insurance claimant statement (M62-CS).
Download the current version from the source each time; forms change without notice.
Group Life Benefits – Attending Physician’s Certificate of Death
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Canada Life's workplace life claims page says that in some cases the beneficiary or estate representative will need to ask the attending physician for a certificate of death. The claimant downloads form M63 and asks the physician to fill it out, then sends it with the other claim forms.
Canada Life accepts signatures in ink, by stylus or finger on a touchscreen, as an inserted image of a handwritten signature, or through a validation system such as Docusign. It does not accept forms with a typed signature, and the forms should be completed in Adobe Reader XI or higher rather than a browser.
It asks you to certify the person's name, employer and date of death, the chief or primary cause and any contributing or secondary cause, when the illness was diagnosed, when it became severe enough to prevent work, the manner of death and whether the deceased smoked and for how long.