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- Click ‘Get Form’ to open the assurance combined r clamation in the editor.
- Begin by filling out the 'Déclaration du Demandeur' section. Enter your name, address, and contact information in the designated fields. Ensure all details are accurate and legible.
- Provide information regarding the incident or illness. Specify the date, time, and a detailed description of how it occurred. If necessary, attach additional documentation.
- If applicable, complete the 'Déclaration de l’Employeur' section by providing your employer's details and confirming your absence from work due to the incident.
- For medical information, have your healthcare provider fill out the 'Déclaration du Médecin Traitant' section. This includes diagnosis details and treatment history.
- Review all sections for completeness before submitting. A fully completed form helps avoid delays in processing your claim.
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