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The document is an application form for the Medical Services Plan (MSP) regular premium assistance in British Columbia, Canada. It requires applicants to provide personal and financial information, including net income and deductions, to determine eligibility for premium assistance based on income levels. The form also includes a declaration and consent section for income verification with the Canada Revenue Agency. Additionally, it outlines the types of assistance available, benefits for families, and monthly rates based on adjusted net income.

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2019	4.8 Satisfied (205 Votes)
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