Sun Life uses GSTDFM-9858 when an employee covered by a Sun Life private or equivalent state paid family and medical leave plan needs leave for their own serious health condition. The provider checks the qualifying category, from inpatient care and pregnancy to organ or bone marrow donation, and estimates continuous, intermittent or reduced-schedule leave. Sun Life decides the claim.
The employee completes Section 1 and signs; the employee's health care provider completes Section 2 with license and NPI numbers, Parts A and B, and signs Section 4.
Download the current version from the source each time; forms change without notice.
PFML Own Serious Health Condition Certification
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 and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Yes. The provider instructions ask that the completed form be returned to Sun Life or to the employee. Sun Life accepts it by mail, email or fax, and the employee is responsible for getting it there within 15 days of requesting leave.
Yes. Pregnancy is one of the Part A categories, with the expected delivery date and a question about whether this is a pregnancy or childbirth complication. Planned treatments such as prenatal appointments are listed in Part B.
GSTDFM-9858 certifies only the serious health condition for statutory leave. GSTDFM-9859 combines that certification with a short-term disability provider statement, adding diagnosis, testing, restrictions and return-to-work questions needed for disability benefits.