Main Content
Please select a group forms category

Didn’t find the form you were looking for? Request it at group.csu@empire.ca


Favourite Form Name Download
Favourite GH-0054-EN Attending Physician's Statement - Short Term Disability Claim Download
Favourite G-0058-EN Attending Physician's Statement, Long Term Disability (LTD) Download
Favourite G-0019-EN Claimants Statement For Disability Benefits Download
Favourite G-0061A COST PLUS BENEFIT CALCULATION FORM - for Provinces outside ON or QC Download
Favourite G-0061C COST PLUS BENEFIT CALCULATION FORM - ONTARIO Download
Favourite G-0061B COST PLUS BENEFIT CALCULATION FORM - QUEBEC Download
Favourite COVID-19 Plan Member Confirmation of Illness Form Download
Favourite GHD-03MD-EN Dental Claim Form Download
Favourite GB-0002-EN Employer's Statement - Group Long Term Disability Claim and/or Life Waiver of Premium Claim Download
Favourite G-0006-EN Extended Health Benefit & Health Care Spending Account Claim Form Download
Favourite GH-05MD-EN Extended Health Claim Form Download
Favourite G-0033-EN Group Change Form (Insured Employee) Download
Favourite G-0008-EN Group Change Form Plan Administrator Changes Download
Favourite GB-0005-EN Group Dependant Children Health Information Download
Favourite GB-0004-EN Group Employee Health Information Download
Favourite GB-0040-EN Group Enrolment Form Download
Favourite GRP-1112-EN Group Spouse Health Information Download
Favourite G-0032-EN PAD authorization - Pre-Authorized Debit (PAD) Download
Favourite Plan Administrator Website Registration Download
Favourite Prior Authorization Drug Program List of Special Authorization Drugs Download
Favourite Prior Authorization Request Form Download
Favourite GH-0053-EN Weekly Indemnity (Short Term Disability) Claim Form - Employee's Statement Download
Favourite GH-0052-EN Weekly Indemnity (Short Term Disability) Claim Form - Employer's Statement Download