Skip To Content

Forms & Booklets

Critical Illness – Kidney Failure Major Organ Transplant or Failure on Waiting List Aplastic Anemia

Choose how to get the form and submit

1

Step 1

step

Print the form once downloaded

Download the Form Here
2

Step 2

step

Fill in the form using blue ink pen

3

Step 3

step

Once the form is completely filled out this needs to be submitted with an accompanying

  1. Cover Page & Instruction Sheet (download here)

  2. Claimant Statement (download here)

  3. Physician Statement (this form)

Please scan / take high resolution photos of all documents and Upload Here

These forms can also be submitted in person or mailed at:
LiUNAcare Local 506
3750 Chesswood Drive, Suite 1
Toronto, ON M3J 2W6

Already have Forms to Submit?

Submit Forms

Get Mobile Access to Your Benefits

LiUNAcare Local 506 mobile apps submit it faster and easier to make claims and get medical assistance – from wherever you are with your smartphone, tablet or desktop.

Check Out Our Mobile Apps

See how easy it is to submit claims and get medical support using our apps – and download them right now!