Benefit & Assistance

These are the forms used for submission of claims Short Term Benefits, Long Term Benefits and Medicare Benefits.

Select the required form from the list.
Benefit & Assistance Update
B.44 Industrial Accident Form required for submission of claims for industrial accident/injury benefit. 03.22.2013
  B.44 Self Employed Form required for submission of industrial accident for self-employed persons 03.22.2013
B.47 Disablement Form required for submission of claims for disablement benefit. 09.14.2009
B.51 Funeral Form required for submission of claims for funeral benefit. 09.14.2009
  B.58 Retirement   This form needs to be completed to begin the process associated with Retirement Benefit.   09.14.2009 
  B.67 Beneficiary Deceased   Form required for submission of claims for Survivors Benefit or Assistance.  09.14.2009 
  Med.1 Sickness_Injury  Form required for submission of claims for sickness and injury benefits.  03.12.2013 
Med.1A Sickness_Injury Form required for submission of claims for sickness and injury benefits when period of incapacity exceeds 26 weeks.   09.14.2009 
Med.2 Maternity  Form required for submission of claims for maternity benefit/grant for both before and after confinement.   09.14.2009 
Med.3B Maternity Grant (Spouse) Form required for submission of claims for maternity grant, where the spouse's contributions are being used.  09.14.2009 
Med.4 Employer Certificate   Form required for certification or confirmation by the employer of claimants stated period of incapacity.   09.14.2009 
B.75a Assistance Verification Form needed for twice annual verification by pensioners in receipt of long-term Assistance. 09.14.2009
B.75b Benefit Verification Form needed for twice annual verification by pensioners in receipt of long-term Benefits. 04.30.2012
B.80  Termination of Service Lay-Off Certificate 02.01.2011
B.82  Claim For Unemployment Benefit  02.01.2011
Invalidity Benefit Claim Form Invalidity Benefit Claim Form 06.22.2010
Survivors Student Confirmation  Survivors Student Confirmation amended 10.03.2011
Survivors Benefit Claim Form Survivors Benefit Claim Form amended 01.04.2011
Direct Deposit of Benefit/ Assistance to Bank Account Direct Deposit Form for direct banking 06.14.2013