Accidental Death (Basic)
Claim FormLoss of Life caused solely by external, violent, and accidental means.
Member / Spouse / Dependent Children
Accidental Death (Occupational)
Claim FormLoss of Life caused solely by external, violent, and accidental means while on the premises of your employer.
Member Only
Accidental Dismemberment (Basic)
Claim FormAccidental Dismemberment caused solely by external, violent, and accidental means.
Member / Spouse / Dependent Children
Accidental Dismemberment (Occupational)
Claim FormAccidental Dismemberment caused solely by external, violent, and accidental means while on the premises of your employer.
Member Only
Bereavement & Parental Leave
Claim FormReplace lost wages in an event you missed work due to a death in the family or the birth of your child.
Member Only
Bursary Application
ScholarshipThe goal of the Carmen Principato Scholarship Trust Fund is to assist the children of Local 506 Members in obtaining high-quality post-secondary education.
To members contributing into the Carmen Principato Scholarship Trust Fund.
Critical Illness – Additional Dependent Child Critical Illnesses
Claim FormClaim for Critical Illness Diagnosis for Dependent Child Only – Cerebral Palsy, Congenital Heart Disease, Cystic Fibrosis, Down Syndrome, Muscular Dystrophy, Type 1 Diabetes.
Dependent Children Only
Critical Illness – Bacterial Meningitis, Benign Brain Tumor, Coma, Stroke
Claim FormClaim for Critical Illness Diagnosis – Bacterial Meningitis, Benign Brain Tumor, Coma or Stroke.
Member / Spouse
Critical Illness – Cancer
Claim FormClaim for Critical Illness Diagnosis – Cancer.
Member / Spouse
Critical Illness – Heart Related Conditions
Claim FormClaim for Critical Illness Diagnosis – Heart Related Conditions.
Member / Spouse
Critical Illness – Kidney Failure Major Organ Transplant or Failure on Waiting List Aplastic Anemia
Claim FormClaim for Critical Illness Diagnosis – Kidney Failure Major Organ Transplant or Failure on Waiting List, or Aplastic Anemia.
Member / Spouse
Critical Illness – Loss of Sight, Hearing, Speech, Limbs, Independent Existence, Paralysis, Severe Burn
Claim FormClaim for Critical Illness Diagnosis – Loss of Sight, Hearing, Speech, Limbs, Independent Existence, Paralysis, Severe Burn.
Member / Spouse
Critical Illness – Neurologic Disorders
Claim FormClaim for Critical Illness Diagnosis – Neurologic Disorders.
Member / Spouse
Critical Illness – Occupational HIV Infection
Claim FormClaim for Critical Illness Diagnosis – Occupational HIV Infection.
Member / Spouse
Dental Care
Claim FormClaim for all dental care expenses.
Member / Spouse / Dependent Children
Dependent with a Disability Coverage
AdministrationBenefit coverage application for dependents with a disability.
Dependent Children
Direct Deposit Form
AdministrationComplete a direct deposit form to have your claim cheques deposited directly into your bank account.
Member Only
Disability Self Pay Extension Form
AdministrationDisabled and unable to work? Complete the Disability Self Pay Extension form to request to self pay for benefit coverage.
Member Only
Emergency Out of Province Medical
Claim FormClaim a medical emergency while travelling.
Member / Spouse / Dependent Children
Extended Healthcare
Claim FormClaim for all heath care expenses which includes prescription drugs.
Member / Spouse / Dependent Children
Group Legal Claim Form
Claim Form LegalClaim for your legal needs.
Member Only
Group Legal Enrollment Form
Administration LegalGroup Legal Plan Enrollment form prior to claiming for all your legal needs.
Member Only
Hospital Cash Benefit
Claim FormBeen hospitalized? Claim for a daily cash benefit for the duration of your hospital stay to cover for parking, room amenities, etc.
Member / Spouse / Dependent Children
Jury Duty Application Form
Claim FormReplace lost wages in an event you missed work due to jury duty.
Member Only
Life Insurance Claim Form
Claim FormClaim in the event of a death.
Member / Spouse / Dependent Children
Long Term Disability (LTD) Application Package
Claim FormIf you remain totally disabled and have exhausted the Short-Term Disability Benefit.
Member Only
Medical Cannabis Prior Authorization Form
AdministrationComplete this Prior-Authorization form prior to claiming for medicinal cannabis.
Member / Spouse / Dependent Children
Member Change of Address Form
AdministrationMoving and looking to change your home address? Complete the Member Change of Address Form.
Member Only
Member Enrollment/Application Card
AdministrationNew Member Enrollment / Application card or to add / change existing dependents and beneficiaries.
Member Only
Nursing Care
Claim FormIf you require out of hospital home nursing.
Member / Spouse / Dependent Children
Permanent and Total Disability Accident
Claim FormIf you become totally and permanently disabled due to an accident.
Member Only
Replacement Benefit Card Application
AdministrationLost / Misplaced your Member Advantage Benefit Card? Complete the Replacement Benefit Card Application to request a new card.
Member Only
Short Term Disability (STD) Application Package
Claim FormFinancial assistance if you are unable to work due to non-occupational injury or illness.
Member Only
Speech Therapy Medical Questionnaire
AdministrationPhysician to complete the Speech Therapy Medical Questionnaire for dependent children prior to incurring speech therapy claims. Benefit available to dependent children only.
Dependent Children Only
Transfer of Hours
AdministrationComplete this form if you are transferring Locals and are moving your hour bank.
Member Only
Vision Care
Claim FormClaim for all vision care expenses.
Member / Spouse / Dependent Children
Workplace Safety Insurance Board (WSIB) Information Form
AdministrationApproved for W.S.I.B. and unable to work? Complete this Information Form for fund assistance and to request to self pay for benefit coverage.
Member Only
