Short-term—Declaration of Claimant—Injury or illness claim

Step 1: Contact Information

Please note: Contact information provided here will be associated with your SIP claim only.

*Required field

*Surname:

*First name:

Previous surname: Member ID:

*I identify as: If other, please specifiy:

*Date of birth: *Social Insurance Number:

Type date in format mm/dd/yyyy, or use the date picker and click the up/down arrows find date.

Teacher Certificate number L *Total number of years teaching:

To retrieve your teaching certificate number, go to: teacherregulation.gov.bc.ca/LoginInfo/YourAccountLogin.
Enter 6-digit number only; L will be prepended.

*Mailing address:

City: Province: Postal code:

*Personal email:

*Primary phone number:

Alternate phone number: