Industry initial medical statement used for Saskatchewan Blue Cross disability claims.
- Completed by
- Attending physician or other medical provider
- Issued by
- Saskatchewan Blue Cross
- Format
- Language
- English
Saskatchewan Blue Cross DISB-1006: Proof of Death
Saskatchewan Blue Cross asks the deceased's physician for this one-page statement as proof of death on a life insurance claim. It records the cause of death and the disease, injury or condition directly leading to death with onset dates, when the deceased was advised of it, and treatment by you and others during the previous 5 years. The claimant completes the separate Individual Life Claim Form (DISB-1014).
Who completes it
The physician completes the whole statement and signs it with their printed name, address and phone and fax numbers. The claimant, such as a beneficiary, trustee or executor, completes and signs the Statement of Claimant on DISB-1014 before a witness.
Submitting and payment
- How to submit it
- Saskatchewan Blue Cross's forms page presents its claim forms for submission by mail, and the statement shows the insurer's Saskatoon mailing address at the top.
Good to know
- The form looks back 5 years: whether you treated or advised the deceased before the last illness, the dates you first and last saw them, and other physicians or facilities involved.
- Give details of conditions and dates whether or not they relate to the cause of death, both for your own care and for treatment the deceased received elsewhere.
- The medical certification follows the World Health Assembly's 1948 recommendations, and the form asks you to conform to the International List of the Causes of Death.
- The notice to physician says the statement is kept in a life file and may be accessible to the beneficiary, the deceased's estate and applicable reinsurers.
Get the official form
Download the current version from the source each time; forms change without notice.
Proof of Death Physicians Statement
Fill it with Vero
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
How this list is checked
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Frequently asked questions
What does Saskatchewan Blue Cross's proof of death statement ask?
It asks for the deceased's name, residence, age, date of birth, date and place of death, the cause of death and the condition directly leading to death with dates of first onset of symptoms, and the date the deceased was advised of it. It then covers treatment by you and others during the last 5 years.
Is DISB-1006 a fillable form?
Yes. Saskatchewan Blue Cross posts it as a fillable one-page PDF, edition DISB 1006 (01/20), under Life and Accidental Death and Dismemberment claims, alongside the Life Insurance Benefit Claim (DISB-1014), the Application for Terminal Illness Benefits (DISB-1002) and the Accidental Dismemberment Claim (DISB-1020).