Personal information
Name and plan information
Current information:
John Doe
Plan contract #: 00000
Member certificate #:99999
Address
Current address:
123 MAIN STREET
KITCHENER
Ontario
N2L 4N4
CANADA
Change address:
Current email address:
Sample@sample.com
- I will not receive notification when my account is used to start a password reset request.
- I will not receive notification when my claim statements are available online.
- I will no longer be able to submit claims online.
Phone
Current phone number:
(555) 555-5555
New phone number:
- I will no longer be able to submit claims online.
