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Forms & Booklets

Critical Illness – Loss of Sight, Hearing, Speech, Limbs, Independent Existence, Paralysis, Severe Burn

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, CLAIMANT STATEMENT, PHYSICIAN STATEMENT (ALL FORMS INCLUDED IN ONE PDF)

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

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