CSA Claim Forms 2026

1. Click ‘Get Form’ to open the CSA Claim Form in the editor.
2. Begin with Section A: Employee Information. Fill in your Plan Number, I.D. Number, and personal details such as your Last Name, First Name, Address, and contact numbers.
3. If submitting on behalf of a dependent, complete Section B: Dependent Information with their details including First Name, Last Name, and Date of Birth.
4. In Section C: Trip Details, provide information about the trip's purpose, destination, scheduled departure and return dates.
5. Indicate the Type of Loss in Section D by checking the appropriate box for Trip Cancellation, Interruption, or Extension. Provide relevant dates and details regarding the loss.
6. Complete Section E: Statement of Expenses Claimed by listing each type of expense incurred along with the date and amount paid.
7. In Section F: Statement of Other Coverage, disclose any other insurance coverage that may apply to this claim.
8. Finally, ensure all sections are completed accurately before signing and dating at the end of the form.

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