Forms

Claim Forms


Claim forms are available from the Administrative Agent or downloaded online. The downloadable claim forms are for eligible active members and eligible dependents of the Local 3000 Members Benefit Fund as listed below.

Please be sure to complete them fully, attach necessary original paid in full invoices along with any other original documentation where applicable and keep a copy for your records to substantiate your claims, and submit to the following mailing address:

LiUNAcare Local 3000
90 Burnhamthorpe Road West
Suite 300, Mississauga, Ontario
L5B 3C3

Vision Claim Form

Policy 177882

Download Form

Dental Claim Form

Policy 177882

Download Form

Extended Health & Drugs Claim Form

Policy 177882

Download Form