First Nations Insurance Services Limited Partnership

Home

FNIS Group Insurance Association
  Plan Forms




Great West Life Printable Forms



Manulife Financial Pension Forms

SunLife Financial Pension Forms

Other Pension Forms

Request a Quote




Forms & Downloads - FNIS Group Insurance Association Plan
FNISLP Group Insurance Death Claims


BASIC, DEPENDANT LIFE & OPTIONAL LIFE INSURANCE

The following three forms must be completed and forwarded to First Nations Insurance Services Limited Partnership's office for processing in order to claim life benefits for either an employee or an eligible dependent's death

DEATH CLAIM FORM
One of these forms must be completed by each beneficiary (or on behalf of each beneficiary where a minor is involved) in the event of the death of an employee and return form(s) to First Nations Insurance Services Limited Partnership's office for processing. Download Form

  • Statement of Employer
    Employer must complete section
  • Employee Information
    Employer must complete this section in the event of an employee's or his/her
    eligible dependent's death.
  • Statement of Claimant
    Each claimant/ beneficiary (designated by deceased employee) must complete this section
  • Complete If Death Was Result of Accident
    Each claimant/ beneficiary (designated by deceased employee) must complete this
    section where death of Employee/ Eligible Dependent was a result of an accident.
  • Certification
    Each claimant/beneficiary (designated by deceased employee) must complete and have their
    signature witnessed in this section
  • + Blue Cross
    Each claimant/ beneficiary (designated by deceased employee) must complete and have
    their signature witnessed in this section.

Proof of Death Physician's Statement
The Claimant/ beneficiary (designated by deceased employee) must have this form completed by
Attending Physician. Any charge associated with the completion of this form is the claimant's
responsibility. Download Form

BASIC ACCIDENTAL DEATH AND DISMEMBERMENT &
VOLUNTARY ACCIDENTAL DEATH AND DISMEMBERMENT

Employer/ Employee must notify First Nations Insurance Services Limited Partnership, in writing, within 30 days of Accidental Death or Dismemberment.

Group Life/Accidental Death Claim Form—Employer’s Statement, Group Life/Accidental
Death Notice of Claim and Group Life/Accidental Death Claim Form Physician’s Statement

  • The Group Life/Accidental Death Claim Form—Employer’s Statement
    must be completed by the Employer
  • The Group Life/Accidental Death Notice of Claim form must be completed
    by each beneficiary designated by deceased employee.
  • The Claimant must have the Group Life/Accidental Death Claim Form
    Physician's Statement completed by the Attending Physician.

    Download Form



 

Contact Us Today! Quality Company Quality People Our Logo's Story Forms & Downloads FNIS Events Other Links Privacy Legistlation _blank Copyright © 2005 First Nations Insurance Quality Company Quality People Our Logo's Story Quality Services