My members / Add a member / Personal information

Add member

Name:

John Smith

Plan contract:

0011112

Division:

004

Plan:

A - Staff (Employee Levels 1 to 9)

Eligibility information

Member certificate #: *

Payroll #:

Hire date (DD/MM/AAAA):

Tax exempt: Yes

Is the member an existing employee who has just become eligible to be enrolled in the benefit plan? (Contract to permanent or part-time to full-time)?

Yes No

Waive waiting period? Yes No

Effective date of eligibility to enrol (DD/MM/AAAA):

Salary information

Salary: *

Salary frequency: *

Hours per week: *

Occupation code:

Home province/state: *

Work province/state: *

Address information

Street/R.R.:

P.O. Box Apt/Unit:

City:

Province/state:

Postal/Zip Code:

Country:

Direct deposit for health and/or dental claim payments

Transit number:

Institution number:

Account number:

Where can I find the member's banking information?