Disability Income Plan Forms

Forms marked with an asterisk * are fillable. That means you can complete the form on your computer. Once complete, print and sign the form and send it to the address indicated below:

Please submit completed documentation to:
Public Employees Benefits Agency, Disability Benefits
110 – 1801 Hamilton Street
Regina, SK Canada S4P 4W3
OR:
Dipcoord_inquiry@peba.gov.sk.ca

 

 

You will require Adobe Acrobat Reader to view and complete any forms. These forms work best with Google Chrome or Firefox web browsers. 

Check out our helpful checklists below:

DIP_employee application checklist

DIP_employer application checklist

 

Attending Physician's Statements

The group plan number for the following forms is 57402.