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Please download and fill out the forms below and fax back to 250-383-1603 or scan and email them to Then please mail the original hard copies to:

210-2750 Quadra Street
Victoria, BC  V8T 4E8

Health & Welfare Benefits:

Benefit Plan Information

Group Life Insurance Form

Pacific Blue Cross Group Application Form

Pacific Blue Cross Dependent Change Form

Bereavement Leave Claim Form

Jury Duty Leave Claim Form

Direct Debit Form (Optional) For Membership Dues:

Pre-Authorized Dues Withdrawal Form

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