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Click ‘Get Form’ to open the Group benefits enrolment form in the editor.
Begin by completing Section 1, which is designated for the plan administrator. Fill in details such as Contract number, Class/Plan, and Plan member ID.
Proceed to Section 2, where you will enter your personal information. Ensure you print clearly and provide your full name, address, date of birth, and gender.
In Section 3, indicate your marital status and language preference. This section also includes options for coverage selection—choose between Single or Family coverage.
If applicable, complete Sections 4 through 6 for banking details and dependent information. Attach any required documents like a void cheque for direct deposit.
Finally, review all sections for accuracy before signing and dating the form in Section 10. Submit it back to your plan administrator.
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