* 1. Enter the name of your group (e.g. the company, association or organisation you belong to that may make you eligible to benefit from Intact Insurance's Group Home and Automobile Insurance Program

* 2. Please enter your contact information:

By completing the above form, you authorize Intact Insurance or one of its independent brokers to contact you by phone, email, or other means, in order to offer you an insurance quote or to give you information about Intact Insurance products and services, and you are automatically entered in the From dream to reality Contest. You may withdraw your consent at any time.

*Contest begins December 1, 2016 and ends December 31, 2017. The draw will be held on January 20, 2018. The prize consists of one (1) cheque in the amount of CAN $5000. Certain conditions, limitations and exclusions apply. The contest is open to residents of the Province of Quebec who are employees or retired employees of an eligible group. The winner will be required to correctly answer a mathematical skill-testing question. For full contest rules, write to: Intact Compagnie d'assurance, 2450 Girouard Ouest, Saint-Hyacinthe, QC J2S 3B3.© 2017, Intact Insurance Company. intact.ca. All rights reserved.

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