Plan Forms

Forms marked with an asterisk * are fillable. That means you can complete the form on your computer. Once complete, print and sign the form and send it to the Plan.

You will need Adobe Acrobat Reader to view and complete any forms. These forms work best with Google Chrome or Firefox web browsers.

Check out our helpful checklists and forms below:

Employer Forms

Employer's Statement Part A*

Employer's Statement Part B*

Rehabilitation Earnings Statement*

Enrolment Form*

Accumulation of the Qualifying Period on a Non-Consecutive Basis (85 Sick Days) (2024-2025)

Coverage While on Leave of Absence or Layoff*

Employee Forms

DIP Employee Application Checklist

Employee's Statement*

Attending Physician's Statement - Long Term Disability Claim* - Group plan number 57402