Claim for Pension by Spouse or Children

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Title Claim for Pension by Spouse or Children
Description Used by a spouse or dependents of a deceased worker. The workers' fatal accident or occupational disease incurred in the course of their employment. This application is needed to determine if applicant(s) is/are entitled to a survivor benefit.
Document number F242-056-000
How to get this document
Alt Language(s) Español
Valid dates 03/2008, 11/2009
Contact information
Related information
Documents

Address Change Request for Pensioners


Authorization for Deposit of Payments


Declaration of Entitlement for Dependent of Deceased Worker Benefits Under Industrial Insurance


Claim for Pension By Dependents
Declaration of Entitlement for Guardian Benefits under Industrial Insurance
Declaration of Entitlement for Totally Disabled Worker Benefits Under Industrial Insurance
Declaration of Entitlement for Widow or Widower Benefits Under Industrial Insurance
Verification of School Enrollment
Websites Workers' Comp Claims

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