Retired Members | Forms

Retiree Program Withdraw Notification

Coverage Details

Description

The Retiree Program Withdraw Notification is for current Retirees that wish to withdraw from the Retiree Benefit Program.

Applicable for

Member Only

Submit your form online:

Step 1

Download, print and fill out the form.

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Step 2

Upload the form using our online submission form.

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Submit by mail:

LiUNAcare Local 506
3750 Chesswood Drive, Suite 1
Toronto, ON M3J 2W6

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Retiree Program Withdraw Notification

Coverage Details

Submit your form online:

Submit by mail:

Get Mobile Access to Your Benefits

Check Out Our Mobile Apps

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Retiree Program Withdraw Notification

Coverage Details

Submit your form online:

Submit by mail:

Get Mobile Access to Your Benefits

Check Out Our Mobile Apps

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