Forms & Resources

Please visit the Benefit Plan Summaries page for information regarding your benefit eligibility. 

All forms must be returned to HR (benefits@sfu.ca) except as noted below.

Extended Health and Dental

Pacific Blue Cross 

Forms and Resources

Description

Pacific Blue Cross Enrollment form To enroll/re-enroll in PBC Extended Health and/or Dental plans 
  • Employee Policy number: 902505
  • Retiree Policy number: 909903
  • Member ID number: Your SFU ID
Pacific Blue Cross Change form To make changes to your plan (add/remove dependent, address change, etc.)
Declaration of Co-Habiting Relationship To declare your common-law partner; provide with PBC Enrollment/Change form  
Dental Plan Refusal for Employees in CUPE To opt out of Dental plan (CUPE only)
Extended Health Online Claims (Employees + Retirees) To submit your claims online through your PBC Member Profile
Extended Health Claim form (Employees) To submit your claims manually - please mail directly to PBC
Extended Health Claim form (Retirees) To submit your claims manually - please mail directly to PBC
Cancellation of Benefits To terminate one or more benefit plan enrollments
TSSU Request for Continued Benefit

To request continued Extended Health coverage (TSSU members only)

TSSU Dental Reimbursement Application

To request reimbursement for Pacific Blue Cross Personal Dental Plan (TSSU members only)

  • Must submit to HR no later than the end of week 12 of the semester to which the reimbursement applies

Life Insurance

Manulife Basic Life Insurance

Forms and Resources

Description

Life Insurance Beneficiary Designation form

To designate/change basic and/or optional life insurance beneficiary/ies

  • Plan number (basic): GL 10794
  • Plan number (optional): GL 37722
  • Certificate number: Your SFU ID
  • Plan Sponsor name: Simon Fraser University
Life Insurance Conversion To convert Group Life coverage to an individual policy upon termination/retirement

Manulife Optional Life Insurance 

Forms and Resources Description
Optional Life Insurance and Evidence of Insurability Application

To enroll in Optional Life Insurance. 

  • Plan member cetificate number: Your SFU ID
  • Class: Leave blank
  • Eligibility Date: Leave blank
  • Please do not mail directly to Manulife, please submit to Benefits@sfu.ca for completion of Part 1. We will submit it to Manulfe on your behalf for approval. 
Optional Group Life Insurance Premiums To view Employee and Spousal Plan monthly rates
Life Insurance Beneficiary Designation form

To designate/change basic and/or optional life insurance beneficary/ies

  • Plan number (optional): GL 37722
  • Certificate number: Your SFU ID
  • Plan Sponsor name Simon Fraser University
Optional Life Insurance Non-Smoking Declaration To update status from smoker to non-smoker
Life Insurance Conversion To convert Group Life coverage to an individual policy upon termination/retirement

Accidental Death and Dismemberment (AD&D)

Basic Accidental Death and Dismemberment

Forms and Resources Description
Basic Accidental Death and Dismemberment Change of Beneficiary

To designate/change beneficiary/ies

  • Provider: Industrial Alliance
  • Policy number: 119-4575

Optional Accidental Death and Dismemberment 

Forms and Resources Description
Vountary Accidental Death and Dismemberment Application

To enroll in Employee or Family Plan

  • Provider: Industrial Alliance
  • Policy number: 119-4637
Voluntary Accidental Death and Dismemberment Change of Beneficiary To designate/change beneficiary/ies

Pension and RRSP

Administrative/Union Staff

Forms and Resources Description
Staff Pension Plan Declaration of Beneficiary

To designate/change beneficiary/ies

  • Please submit to HR
Staff Group RRSP Enrolment Please submit directly to Sun Life
Staff Tax-Free Savings Account (TFSA) Enrolment Please submit directly to Sun Life
Staff Non-Registered Savings Plan (NREG) Enrolment Please submit directly to Sun Life
Staff Voluntary Registered Pension Plan (RPP) Contributions Please submit to HR
Spouse's Waiver of PreRetirement Survivor Benefit Spouse's waiver of Beneficiary right to benefits in a Pension Plan, Locked-IN Retirment Account, Life Income Fund or Annuity Before Payments Start
Lump Sum Contribution To submit lump sum RRSP/TFSA/NREG contribution. Please submit directly to Sun Life. 
Direct Transfer of Assets Transfer of registered and non-registered plan assets from another financial institution to Sun Life Financial

Faculty

Forms and Resources Description
Faculty Group RRSP Enrolment Please submit directly to Sun Life
Faculty Tax-Free Savings Account (TFSA) Enrolment Please submit directly to Sun Life
Faculty Non-Registered Savings Plan (NREG) Enrolment Please submit directly to Sun Life
Faculty Voluntary Registered Pension Plan (RPP) contributions Online through Sun Life member account
Faculty Pension Plan Declaration of Beneficiary  Online through Sun Life member account
Lump Sum Contribution Please submit directly to Sun Life

Marriage Breakdown Forms

Academic Staff

Forms and Resources Description
Form P1 Claim and Request for Information and Notice
Form P3 Request for Transfer from DC Account
Form P7 Withdrawal of Notice/Waiver of Claim
Form P9 Agreement to have Benefits Divided Under Part 6

Administrative/Union Staff

Forms and Resources Description
Form P1 Claim and Request for Information and Notice
Form P2 Request for Designation as Limited Member
Form P4 Request by Limited Member for Transfer or Separate Pension
Form P7 Withdrawal of Notice/Waiver of Claim
Form P9 Agreement to have Benefits Divided Under Part 6

Paid & Unpaid Leaves

Pregnancy & Parental Leave

Forms and Resources Description
APEX: Pregnancy & Parental Leave Information A reference guide for pregnancy & parental leaves for APEX employees
APSA: Pregnancy & Parental Leave Information A reference guide for pregnancy & parental leaves for APSA employees
CUPE: Pregnancy & Parental Leave Information A reference guide for pregnancy & parental leaves for CUPE employees
Poly Party: Pregnancy & Parental Leave Information A reference guide for pregnancy & parental leaves for Poly Party employees

Personal Leave

Forms and Resources Description
Application for Extended Leave of Absence without Pay

For Union and Administrative/Professional Employees Taking Personal Leave of Absence without Pay Exceeding 20 days