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Brampton Professional Fire Fighters


Benefits/ WSIB Resolution Form

Please fill out this form completely to assist us in helping resolve your claim.

Name*
Phone Number*
Badge Number*
E-mail Address*
Must be a valid e-mail address, e.g. email@domain.com.
Active/ Retired Member*
Active Member
Retired Member

Date form was submitted

Month*
Day*
Year*

Benefits/ WSIB Issue

Benefits/ WSIB Issue*
Benefit Issue
WSIB Issue

Describe your Issue

Briefly describe your issue. Please note that this information may be sent to the City Benefits staff to administer.

Issue*

Note: * indicates required information.

 

 
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