Forms & Tools - Disability

posting date Revised: January 2022 print page Print this page Email link to page Email the link
Downloadable Forms

We have provided links to downloadable versions of many OPTrust forms, checklists and other tools in Acrobat PDF format. You will need Adobe’s Acrobat Reader to use these forms. If the Acrobat Reader is not installed on your system, see your system administrator or download a free copy

To use the downloadable forms, simply click on the links below. If your Acrobat Reader is set up to work with your browser, the form will open inside the browser window. Otherwise, you will be prompted to save or open the file; choose Open and click OK to open the form. 

Next, enter the required information and print the number of copies you require. Once all the required signatures are complete, submit one copy to OPTrust, provide a copy to the member and keep a copy for your records, as required. 

Disability Benefits - Forms and Tools
  • Termination of Membership – Application For Entitlement form (OPTrust 1012)
  • Member’s Statement on Disability (OPTrust 3001)
  • Employer’s Statement on Disability (OPTrust 3002)
  • Medical Examination Report (OPTrust 3003)
  • Applying for an OPTrust Disability Benefit fact sheet
Shortened Life Expectancy  - Forms and Tools
  • Application for Lump Sum Payout due to Shortened Life Expectancy (OPTrust 3006)
  • Termination of Membership – Application for Entitlement  (OPTrust 1012)