General Forms | Pension Plan Forms | Group Insurance plan forms | Pensioner Forms

general Forms

CSSB Registration for Online Services

Special Service Buy Back Application

Pension Plan Forms

CSSB 1001/01-06 Registration Certificate

CSSB 1002R Retirement Notice

CSSB 1002T Termination Notice

CSSB 1003/00-11 Superannuation Contributions in Arrears

CSSB 1004/00-11 Notice of Desire to Become a Contributor to the Civil Service Superannuation Fund

CSSB 1005/01-10 Form of Election for Employees on Education Leave - Allowance Paid

CSSB 1006/01-10 Form of Election for Employees on Education Leave - With Full Salary

CSSB 1007/97-01 Form of Election for Employees on Education Leave - With Part Salary

CSSB 1008/97-01 Form of Election for Employees on Education Leave - Without Salary

CSSB 1009/97-01 Form of Election for Employees on Loan To Union

CSSB 1010/97-01 Form of Election for Employees on Loan - With Part Salary

CSSB 1011/97-01 Form of Election for Employees on Loan - Without Salary

CSSB 1012/97-11 Form of Election for Employees Receiving Workers' Compensation Benefits

CSSB 1015/01-10 Form of Election To Contribute on Year-Round to Seasonal Service

CSSB 1016/01-10 Form of Election To Contribute on Reduced Hours in Last Five Years Prior to Retirement

CSSB 1017m/01-01 Form of Election to Contribute on Maternity Leave

CSSB 1017p/01-01 Form of Election to Contribute on Parental Leave

CSSB 1018/97-01 Employee Data Change Form

CSSB 1019/97-01 Application to Purchase Prior Non-Pensionable Service

CSSB 1020/97-01 Proof of Age Affidavit

Application to Purchase Special Service Buy Back

Group Insurance Forms

CSSB.8001 - Life Insurance and Dependents Insurance Appointment and Election Statement

CSSB.8002 - Application for Changes to Dependents Insurance

CSSB.8003 - Application for Changes In Life Insurance Class

CSSB.8004 - Continuation of Group Insurance During An Employer Approved Leave of Absence or Lay-Off

CSSB.8005 - Waiver of Group Insurance During An Employer Approved Leave of Absence or Lay-Off

CSSB.8006 - Life Insurance Retirement Notice

CSSB.8007 - Bi-Weekly Contribution Remittance Report

CSSB.8008 - Insurance Waiver Application - memo

CSSB.8009 - Life Insurance Death Claim - memo

CSSB.8010 - Dependents Insurance Death Claim - memo

CSSB.8011 - Accidental Disablement Claim - memo

CSSB.8012 - Request for Dependents insurance or an Increased Number of Units - memo

CSSB.8013 - Request for a Higher Life Insurance Class - memo

M4437 [previously 1285] - Application for Accidental Disablement or Specific Loss

M62-8/06 [previously 254] - Death Claim Report - Group Life/Dependents/Accidental Death

M6621-12/04 [previously G220136H] - Statement of Health for Group Insurance

M6622-12/04 [previously G0056ADCE] - Application for Dependents Coverage

M6697-2/06 [previously 1536] - Beneficiary Designation Form

M6723-5/06 [previously 1537] - Certificate By Employee of Change in Name

M6797(ER330780) [previously 930K] - Waiver of Premium Benefit Application - Employer Statement

M6809 [previously 1541] - Form of Assignment

Pensioner Forms

All Charities Campaign Pledge Card

Manitoba Blue Cross - Dental Claim Form

Manitoba Blue Cross - Extended Health Benefits Claim Form

Manitoba Blue Cross - Vision Care Claim Form

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