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Benefit forms

Information and forms for specific plans

Attention UFCW members

Due to COVID, there has been some staffing challenges at the PBAS office, to help streamline this process, PBAS has provided the Union with some direct email addresses for you to submit your claims to:

Safeway, Freshco, Canada Bread, Agropur, Red River Co-Op: safeway1@pbas.ca
Superstore, NoFrills: westfair@pbas.ca
HyLife, Freezerco: hylifefoods@pbas.ca
Maple Leaf: mapleleaf@pbas.ca
MFCW Dental: mfcwdental@pbas.ca

The General Delivery mailbox is still being monitored and forwarded to the appropriate individuals as well, at winnipeg@pbas.ca.

These are the forms that members require to obtain various benefits from the union, or to report information to the union. All of these forms are available from Local 832 offices, or you can click on a form’s name to obtain the online version of it.

Most of these forms are provided as PDFs, which can be downloaded and printed, then mailed or otherwise given to the benefits office at 880 Portage in Winnipeg, a UFCW office or union representative. Use of PDFs requires that Adobe Reader or similar program be installed on your computer. If you don’t have it, a free copy can be downloaded at Adobe.

A few of the forms are interactive and can be completed and submitted through your browser. Information provided through interactive forms are transferred to UFCW Local 832 using a secure procedure. For more information of the steps taken by UFCW Local 832 to ensure the security of information it receives and stores about its members, please see the Privacy Policy.

Forms for Manitoba Food and Commercial Workers Dental Plan

Forms for Safeway / Red River Co-op / Agropur / Canada Bread Members

Forms for Loblaw Members

Forms for Maple Leaf Members

Heavy Workload Forms (Clinical Staff)

Forms for HyLife Members

Scholarships

Visit our Scholarships page for more information.

Authorization to Release Information

If you want to have information provided to a doctor, other individual or organization by a UFCW/PBAS administered plan or fund, you must provide a release form to the plan or fund. Each form is specific to one plan or employer. They can be downloaded in PDF format by clicking on the appropriate link below.

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