Unistar SRI

“To be yourself in a world that is constantly trying to make you something else is the greatest accomplishment.”

- Ralph Waldo Emerson, American poet, 1803 – 1882

Short Term Disability Claim Forms

Please use these forms for Short Term Disability Applications only. See "Notice of Claim Form" below for other applications.

English	French

Employer Statement of Absence for STD Benefit	Employer Statement of Absence for STD Benefit - French
Attending Physician Statement	Attending Physician Statement - French

Long Term Disability Claim Forms

Employer's Statement Claim for LTD Benefits	Employer's Statement Claim for LTD Benefits - French
Notice of LTD Claim Form	Notice of LTD Claim Form - French

Critical Illness

Life Waiver of Premium

Basic Life

Basic AD&D

Dependent Life

Administrative Forms

Unistar Master Application
Trustee Appointment
Lifestyle Coverage Change
Declaration of Insurability Form	Declaration of Insurability Form - French
Pre-Authorized Business Debit (PAC)
Employee Application for Group Coverage
Lifestyle Adjustment/Change
Waiver of Excess Coverage Notice
Consent to change of Irrevocable Beneficiary