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NON-LINE-OF-DUTY DISABILITY APPLICATION 2026
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- Click ‘Get Form’ to open the NON-LINE-OF-DUTY DISABILITY APPLICATION in the editor.
- Begin by entering your personal information in the 'INFORMATION ABOUT YOU' section. Fill in your name, date of birth, address, and telephone numbers clearly.
- Indicate your payroll title and employer. Specify your length of service in years and months.
- Answer whether you are on payroll and receiving salary. If not, provide an explanation.
- Detail your medical condition(s) that have led to your permanent disability. Use additional sheets if necessary.
- List all doctors who have treated you for your condition, including their specialties and contact information.
- Document any hospitalizations related to your condition, including dates of admission.
- If applicable, answer questions regarding physical or mental incapacitation due to accidents sustained during duty. Provide details as required.
- Complete the beneficiary information section accurately, ensuring all details are correct before signing the application on the reverse side.
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