Long-term Disability Insurance Application

Long-term disability insurance application. Please submit the application via Fax to (314) 589-8110 or e-mail at benefitssection@stlouis-mo.gov. Also please remember to remove Social Security Numbers, or to only include the last four digits.

Publication Date: 12/11/2019
Document Type: Printed Forms and Templates
Sponsor: Employee Benefits

Download

  1. pdf LTD Application (English) (3.54 MB)
  2. pdf LTD Flyer (English) (503.79 KB)
  3. pdf LTD Application (Spanish) (4.29 MB)
  4. pdf LTD Flyer (Spanish) (998.63 KB)

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