Claim Forms

The Claims Period is now closed for regular submissions.

However, in some cases the Administrator may ask Individuals to submit a new Claim Form.

This may apply to you if:

  • You’ve received a letter from the Administrator informing you that information was missing on your original Claim Form.
  • Your First Nations community was recently added to the list of Impacted First Nations.

Completing a Claim Form

The Claim Form is available as a fillable PDF that you can complete and send to the Administrator by email, mail or fax. If you require a paper version of the Individual Claim Form to be sent to you, please contact the Administrator at 1-833-252-4220 (Toll-free).

Individual Claim Form

You only need to complete one Claim Form even if you lived in multiple Impacted First Nations or experienced multiple Specified Injuries.

Representative Claim Form

You only need to complete one claim form even if you lived in multiple Impacted First Nations or experienced multiple Specified Injuries.

Minor Attestation Forms

The Administrator may ask the personal representative of a minor child to fill out a province-specific Attestation Form (excluding those living in Prince Edward Island). This form helps verify the eligibility of the personal representative to receive the child’s payment. The Administrator will provide the required Attestation Form along with the decision letter.

Need help filling out your Claim Form?

Use these Interactive Guides to help you fill out your Claim Form.

Individual Claim Form (including claims for Specified Injuries) 

Representative Claim Form (including claims for Specified Injuries)