Employee Statement Short-Term Disability Claim - cupw-vancouver 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section A, where you will input your personal information. Fill in your name, address, employee ID number, and contact details. Ensure accuracy as this information is crucial for processing your claim.
3. Move to Section B to provide details about your work. Indicate your last day worked, first day of absence, job title, and any relevant duties. This section helps clarify your employment status.
4. In Section C, describe the nature of your disability. Specify if it resulted from an illness or accident and detail how it affects your abilities. This information is vital for assessing your claim.
5. Proceed to Section D to disclose any income or benefits you are receiving. List all applicable sources and their amounts; this ensures transparency in your financial situation during the claim process.
6. Finally, complete Section E by providing information about your healthcare professional. Include their name, specialty, and contact details to facilitate communication regarding your treatment.

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