Supplemental Plan Forms

Form 161 PDF File [40.3 KB] - Past service purchase application form (Supplemental Plan)
Use this form to get a cost quote for purchasing Supplemental Plan past service.

Form 162 PDF File [55.7 KB] - Pre-authorized debit form (Supplemental Plan)
Use this form to change your existing Supplemental Plan past service pre-authorized debit instructions.

Form 301 PDF File [94.3 KB] - Request for a Supplemental Plan cost estimate (for Police, Fire or Paramedic Union or Association use only)
Use this form to request a Supplemental Plan cost estimate when it is not obtainable through the employer.

Supplemental Plan benefits are not automatically provided. Employers can set up Supplemental Plan coverage for a class or classes of members in the police sector, firefighters and paramedics.