In the case of a Member who was not receiving a pension at the time of death, your spouse, named beneficiary or executor of your estate will be required to complete and submit to the administrative agent the following documents:

  • a completed Application for Death Benefits. This form can be obtained by contacting the administrative agent.
  • A copy of proof of death ( death certificate, funeral director's statement);
  • A copy of proof of age for the Member and the applicant (see below for acceptable documents).


Documents acceptable as proof of age are as follows:

  • Birth certificate issued by government authority.
  • Baptismal certificate or church record, which shows date of birth, certified by custodian of such church.
  • Hospital record of birth, which shows date of birth, certified by custodian of such record.
  • Statement of physician or midwife in attendance at birth, stating date of birth as shown in their records.
  • Citizenship papers, immigration papers, military record or passport, which shows date of birth.
  • Life insurance policy issued at least five years ago, which shows date of birth.
  • Signed notarized statements from responsible person(s) having knowledge of date of birth.

Upon receipt of all documents, the applicant will be advised of the death benefit payable, if any.

Please note that all personal information is collected and maintained in accordance with the Personal Information Protection and Electronic Documents Act. (PIPEDA)

Insulators Local 95 Benefit Trust Fund c/o Benefit Plan Administrators 
90 Burnhamthorpe Road West, Suite 300 Mississauga, Ontario L5B 3C3