On this page you will find all our forms available for download.

Banking Instructions Form 

• The Banking Instructions Form is essential to ensure that all reimbursements are paid into the correct bank account. This form must be completed upon enrolment and subsequently whenever there is a change in your bank account details. It is imperative that you inform us in a timely manner to avoid delays or complications with your reimbursements.
• Please click to access the form in English or in French, complete it, and send it back to unsmis@un.org

ASHI Form – For Retirees

• Please complete this form in English or in French, and send it to our team in order to submit your application for After-Service Health Insurance (ASHI) at retirement.

Declaration of Accident Form

• In the unfortunate event of the submission of expenses for reimbursement following an accident, we kindly ask you to complete a Declaration of Accident Form. EN / FR
• This form is essential, as it allows us to verify whether the accident may be service incurred or whether a responsible third party may be involved.

Affiliation Form

• To access the Affiliation Form please click here.
• Please note that it is your responsibility to request enrolment in a health insurance plan within 31 days of a qualifying event (entry on duty, marriage or divorce, birth or adoption of a child, recognition of a secondary dependent, change of duty station, etc.).
• Depending on your organization’s HR system:
  • If your organization uses UMOJA, please do the necessary in Employee Self Service (ESS). Click here to access the UMOJA Self Service job aid for health insurance.
  • If your organization uses Workday, you may request enrolment through Workday directly, or by reaching out to your HR colleagues via Workday Case Management.
  • If your organization does not use UMOJA or Workday, please complete, sign, and send the Affiliation Form to the relevant Human Resources Officer.
• Prior to requesting affiliation we strongly encourage everyone to read the Internal Rules and review the page 'New to UNSMIS', covering the topic of affiliation.
• We would also like to remind insured members that it is their responsibility to inform us of any changes in family structure, such as marriage, the birth of a child, or divorce.

Paper Claim Forms

• We strongly encourage all members to transition from paper submissions to online claims by using the eClaims Portal. For details on how to use the platform, please click here.
• Should you wish to submit a claim in paper form, you may download the claim form here. Please make sure that you sign the form.

Contact Details Update Form

• If you are a retiree or have an extension of coverage, kindly inform us directly of any changes to your residential address or telephone number.
• To report updated contact details, please complete this form and return it by email to unsmis@un.org

Form to Request a Cure

• Please click here to access the form.