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Group Insurance Administration Manual
Pension Plan Administration Manual

Group Insurance Forms

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M6809 Assignment
M6797(ER330780) Group Life Insurance Waiver of Premium Benefit Application – Employer’s Statement
M6797(EE330780) Group Life Insurance Waiver of Premium Benefit Application – Employee’s Statement
M6797(AP330780) Group Life Insurance Waiver of Premium Benefit Application – Attending Physician’s Initial Statement
M6697 Beneficiary Designation
M62 Group Life/Accidental Death & Disablement/Dependents Death Claim Report
M5995(330785) Dependent Insurance Medical Questionnaire
M5995(330780) Group Life Insurance Medical Questionnaire
M4437 Application for Accidental Disablement or Specific Loss – Employer/Policyholder Statement
8016 Retirement Notice for Insurance Only Members
8015 Termination Notice for Insurance Only Members
8014 Registration Certificate for Insurance Only Members
8013 Request for a Higher Life Insurance Class
8012 Request for Dependents Insurance or An Increased Number of Units
8011 Accidental Disablement Claim
8010 Dependents Insurance Death Claim
8009 Group Life Insurance Death Claim
8008 Group Insurance Waiver of Premium
8007 Bi-Weekly Premium Remittance Report
8006 Life Insurance Retirement Notice
8005 Election to Waive Group Insurance During An Employer Approved Leave of Absence or Lay Off
8004 Election to Continue Group Insurance During An Employer Approved Leave of Absence or Lay Off
8003 Application for Changes in Life Insurance Class
8002B Application for Changes to the Dependents Insurance Plan
8002A Application for Coverage in the Dependents Insurance Plan
8001 Group Life and Dependents Insurance Appointment and Election Statement
Member Information Change Form

Pension Plan Forms

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1019 – Application To Purchase Prior Non-Pensionable Service – new version coming!
1015 – Form of Election To Contribute on Year-Round to Seasonal Service – new version coming!
1012 – Form of Election for Employees Receiving Workers’ Compensation Benefits – new version coming!
1011 – Form of Election for Employees On Loan – Without Salary – new version coming!
1010 – Form of Election for Employees On Loan – With Part Salary – new version coming!
1009 – Form of Election for Employees On Loan To Union – new version coming!
1008 – Form of Election for Employees on Education Leave – Without Salary – new version coming!
1007 – Form of Election for Employees on Education Leave – With Part Salary – new version coming!
1006 – Form of Election for Employees on Education Leave – With Full Salary – new version coming!
1005 – Form of Election for Employees on Education Leave – Allowance Paid – new version coming!
Election to Contribute On Reduced Hours in Last Five Years
Prior Year Arrears
Member Information Change Form
Request for Information about Contributing for Maternity, Parental or Adoptive Leave
Notice of Desire to Contribute
End of Service Report (replaces Termination and Retirement Notices) – updated January 2018
Registration Certificate
Application to Purchase Special Service Buy Back