NON-LINE-OF-DUTY DISABILITY APPLICATION 2026

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

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