September 25, 2020  
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Adding or Deleting Dependents

  1. Plan Administrator completes the “Reason for Completion” box and Part 1 of the Notice of Change Form by indicating the Plan Member's identification number, name, effective date of change etc.
  2. Plan Member completes applicable information in Section B of the Notice of Change Form
  3. Fax a copy of this form to your nearest Morneau Shepell office
  4. Retain the original for your files

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Last updated on:  Tuesday, May 29, 2012  Page: 

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