Online Submission of Application Attachments

  • On this page, you can upload and submit the Supporting Evidence Form and other documents that are required to be submitted together with the Application Form and the Supporting Evidence Form (as per the terms of these forms). Please remember that the Supporting Evidence Form and these other documents must be submitted together with and at the same time as your Application Form.

    As a first step, please upload all attachments under the various sections of this page. Once you have finished uploading all attachments, then click “SUBMIT” at the bottom of this page in order to submit all attachments at the same time.

    Where can I find my Application number?

    1. If you submitted an Application Form online, then your Application number was displayed on the confirmation page after the online submission and was also sent to the Applicant’s email address, if any, as provided in the Application.
    2. If you submitted an Application Form via email or regular mail, then your Application number was sent by the Program’s Administrator to the Applicant’s email address, if any, or mailing address as provided in the Application.
    3. If you need help in obtaining your number, please contact the Program’s Administrator at covaxclaims@esis.com for assistance.


  • NOTE: Under each category below, you can only upload a certain number of documents (as specified for each category) at the same time. Once the maximum number of documents you can upload at the same time is reached, please return to this page to upload any additional documents you may wish to submit. You can repeat this operation as many times as necessary.

  • Please upload duly completed and signed “Supporting Evidence Form” using Schedule 3, available here. The Supporting Evidence Form must be completed and signed by one or more Registered Healthcare Professional(s).

    You can upload a maximum of 1 file for this question.

    Drop files here or
  • Please upload invoices, receipts or other proof of payment of any medical expenses (including hospital fees) that were required as a consequence of the injury or illness suffered by the Patient for which this Application is made.

    You can upload a maximum of 3 files for this question.

    Drop files here or
  • If the Patient (1) has died, (2) is a child, or (3) is disabled or otherwise lacks legal capacity to submit this Application for himself/herself, then the person submitting this Application for the Patient must please submit a power of attorney and/or statement notarized by a notary public or other Notary Official confirming that:

    1. the person submitting the Application for the Patient is the legally recognized parent, guardian, heir or legal representative of the Patient, as the case may be; and
    2. if the Patient has died, that the person submitting this Application on behalf of the Patient: (A) is the duly-authorized and legally-recognized representative of all legal heirs of the Patient, as listed in the power of attorney or notarized statement; and (B) has all necessary rights, powers and authority to represent, act for and bind all of such legal heirs; and (C) there are no other legal heirs of the Patient other than those legal heirs who are listed in the power of attorney or notarized statement.

    You can upload a maximum of 1 file for this question.

    Drop files here or
  • If applicable, please upload any other documents or information in support of your Application Form or Supporting Evidence Form.

    You can upload a maximum of 3 files for this question.

    Drop files here or
  • You only need to upload a file in this field if your initial Application has been rejected.

    You can upload a maximum of 1 file for this question.

    Drop files here or