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
FNIS Group Insurance Short Term Disability

The following five forms must be completed, signed and forwarded to First Nations Insurance Services Limited Partnership's office for processing in order to make a claim for Short Term Disability Benefits.

Plan Sponsor's Statement—Claim for Short Term Disability Benefits
Plan Sponsor must complete this form, sign and return it to First Nations Insurance
Services office for processing. Downlaod Form

Short-Term Disability Questionnaire—Physical Job Demands
Plan Sponsor must complete this form, sign and return it to First Nations Insurance
Services office for processing. Download Form

Plan Member's Statement—Claim for Short Term Disability Benefits
Plan Member must complete this form, sign and return it to First Nations Insurance
Services office for processing. Download Form

Attending Physician's Statement (APS)—Short Term Disability:
(General/Psychiatric/Pregnancy/Musculo-Skeletal/Motor Vehicle Accident)

Plan Member must have their Licensed Physician or Specialist complete the applicable
APS, sign and return it to First Nations Insurance Services office for processing.
Download Form

Short Term Disability Return to Work Notice
Plan Sponsor must complete this form, sign and return it to First Nations Insurance
Services office for processing once employee has returned to work. 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 Services Quality People Our Logo's Story