Form Center

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Please check your policy to determine your respective coverage and limitations.

Available Forms

Medical/Dental/Vision Claim
Life/Accidental Death and Dismemberment/Short-Term Disability Claim
Travel, Sickness and Accident (MBA) Claim Forms
Long-Term Disability Claim
Enrollment and Change
Employers Application
CIGNA Life Insurance of Canada Forms

Medical/Dental/Vision Claim
Select a language below to access the Medical/Dental/Vision claim form.

Language Arabic Chinese Czech Dutch English French German Hindi Italian Japanese Korean Portuguese Russian Spanish Thai

Colonial Medical/Dental/Vision Claim - English
Colonial Medical/Dental/Vision Claim - French

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Life/Accidental Death and Dismemberment/Short-Term Disability Claim

Group Proof of Loss Accidental Dismemberment
Group Proof of Loss Accidental Death
Group Proof of Loss Short-Term Disability

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Travel, Sickness and Accident (MBA) Claim Forms
Select a language below to access the MBA claim form.

Long-Term Disability Claim
When submitting an LTD claim, please complete each of these forms in their entirety, in order for your request to be processed as quickly as possible. Contact information, such as phone number and email address is essential so that we may update you on the status of the claim. Please contact CIEB Customer Service with any questions regarding these forms (800.441.2668 or 302.797.3100).

Group LTD Claim
Group LTD Claim - Spanish
Colonial Group LTD Claim
Activities of Daily Living
Medications List
Treating Physician List

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Supplementary Long-Term Disability Claim

Supplementary LTD Claim
Colonial Supplementary LTD Claim

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Travel, Sickness and Accident (MBA) Claim Forms
Select a language below to access the MBA claim form.

Language Chinese Czech English French German Hindi Portuguese Russian Spanish Thai Japanese Italian

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Statement of Physical Condition
The Statement of Physical Condition form may be required to determine if you're eligible under your policy provisions.

Statement of Physical Condition
Colonial Statement of Physical Condition

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Enrollment and Change Form
Select a language below to access the Enrollment and Change Form.

Language English Spanish

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Employers Application

Download here

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CIGNA Life Insurance of Canada Forms

Medical/Dental/Vision Claim - English
Medical/Dental/Vision Claim - French
Statement of Physical Condition Form
MBA Claim Form - English
MBA Claim Form - French
MBA Employer Verification Form
Life/Accidental Death Claim Form
Life/Accidental Dismemberment Claim Form - English
Life/Accidental Dismemberment Claim Form - French
Long-Term Disability Claim - English
Long-Term Disability Claim - French

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