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general Forms

CSSB Registration for Online Services

Special Service Buy Back Application

CSSB Application for Disability Allowance

Pension Plan Forms

CSSB 1001/01-06 Registration Certificate

CSSB 1002R Retirement Notice - requires Adobe Reader 9

CSSB 1002T Termination Notice - requires Adobe Reader 9

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.8002A - Application for Coverage in the Dependents Insurance Plan

CSSB.8002B - Application for Changes to the Dependents Insurance Plan

CSSB.8003 - Application for Changes In LIfe Insurance Class

CSSB.8004 - Election to Continue Group Insurance During An Employer Approved Leave of Absence or Lay-Off
(last updated Sept. 20/10)

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

CSSB.8006 - Life Insurance Retirement Notice - requires Adobe Reader 9
(last updated Sept. 10/10)

CSSB.8007 - Bi-Weekly Premium Remittance Report
(last updated Sept. 20/10)

CSSB.8008 - Group Insurance Waiver of Premium Memo
(last updated Sept. 10/10)

CSSB.8009 - Group Life Insurance Death Claim
(last updated Sept. 10/10)

CSSB.8010 - Dependents Insurance Death Claim
(last updated Sept. 10/10)

CSSB.8011 - Accidental Disablement Claim
(last updated Sept. 10/10)

CSSB.8012 - Request for Dependents Insurance or an Increased Number of Units
(last updated December 2011)

CSSB.8013 - Request for a Higher Life Insurance Class
(last updated December 2011)

CSSB.8014 - Registration Certificate for Insurance Only Members
- use for employees not in CSSB pension plan

CSSB.8015 - Termination Notice for Insurance Only Members
- use for employees not in CSSB pension plan

CSSB.8016 - Retirement Notice for Members with Insurance Only (Not In Pension Plan)
(last updated Sept. 10/10)

M4437 - Application for Accidental Disablement or Specific Loss - Employer/Policyholder Statement

M5995(330780) [previously M6621 and G220136H] - Statement of Health for Group Insurance

M5995(330785) [previously M6622 and G0056ADCE] - Application for Dependents Coverage

M62 (previously 254) - Death Claim Report - Group Life/Dependents/Accidental Death

M6697 [previously 1536] - Beneficiary Designation - updated Aug 5/10

M6723 [previously 1537] - Change in Name Form

M6797(AP330780) (previously 930K) - Waiver of Premium Benefit Application -
Attending Physician's Initial Statement

M6797(EE330780) (previously 930K) - Waiver of Premium Benefit Application -
Employee's Statement

M6797(ER330780) (previously 930K) - Waiver of Premium Benefit Application -
Employer's Statement

M6809 (previously 1541) - Assignment

Pensioner Forms

All Charities Campaign Pledge Card

CSSB Direct Deposit Form

Manitoba Blue Cross - Dental Claim Form

Manitoba Blue Cross - Extended Health Benefits Claim Form

Manitoba Blue Cross - Vision Care Claim Form

Forms with are links off our site, which at times may return a "404 File Not Found" error, due to a change in the link address from the originating site. We try to keep up to date with change but they can happen at any time. If the problem persists, please contact us.

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