Given the current situation and the possibility of delays in postal services, we encourage you to use our online services.
If you have to send us a paper form, please send it, along with any accompanying information or receipts, via our secure forms submission page rather than by mail.
- Fill out and sign the form
- Gather the required supporting documents
- Send everything to the address indicated on the form
Keep copies of all correspondence for at least 12 months.
- Originals will not be returned.
Death Claim – 02227A (PDF, 1.3 MB) Opens in a new window.
This form is filled out by the beneficiaries when a plan member or a dependent dies.
Each beneficiary fills out their own claim form. If there are no designated beneficiaries, the form is filled out by the executor.
Provide the Claim –
Employer’s Statement 12123E (PDF, 1.1 MB) Opens in a new window. along with this form.
Claim – Employer’s Statement – To be completed by the Plan administrator - 12123E (PDF, 1.1 MB) Opens in a new window.
This form is filled out by the employer when a beneficiary submits a death claim.
This form must be submitted with the
Death Claim 02227A (PDF, 1.3 MB) Opens in a new window.. We cannot settle the claim unless all questions are answered adequately.
Death Claim – Physician’s Statement – 14153E (PDF, 1.2 MB) Opens in a new window.
This form must be completed by the physician when required and submitted with the
Death Claim 02227A (PDF, 1.3 MB) Opens in a new window..
Fees charged for this statement are to be paid by the claimant.
Declaration of Status for Deceased Common Law Spouse – Plan member – 01311E (PDF, 96 KB) Opens in a new window.
This form is completed by the plan member if their common law spouse dies.
This form must be signed in the presence of a notary, a lawyer, a police court magistrate, a notary public or any other person able to administer the oath in virtue of the appropriate laws.