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Employee Benefits Claims

Forms to be completed when applying for a disability benefit:

Name of form Form code Download
Claim for Lump sum Disability Benefit and/or Monthly Disability Income Benefit EB2878E & EB2878A ENG | AFR
Top Plan for Executives AE2921 ENG
Notification of Potential Disability Claim EBDC051 ENG
Claim for Terminal Illness Benefit: Declaration by employer EBCL002E & EBCL002E ENG | AFR
Claim for Spouse Disability Benefit EB2877 ENG
Medical Certificate: Proof of Continuation of Disability AE2298 ENG | AFR
Claim for Trauma Benefit EB2475 ENG
Claim for Accident Benefit EBCL003 ENG | AFR
IncomeCare Rehabilitation Questionnaire EBCL004 ENG
IncomeCare Sick: Leave Report Employer EB2799 ENG
Spouses Insurance: Application for Benefit SEB005 ENG| AFR
Universal Education Protector: Claim Form SEB007 ENG| AFR
Nomination for Group Life Insurance SEB003 ENG| AFR
Funeral Aid Insurance: Benefit Claim Form SEB012 ENG| AFR
Statement by Police Service Official to Whom Death was Reported SEB008 ENG
Statement on Death AE1912 ENG| AFR

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