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Get Great West Life Form

R Information form to us by mail or fax to the address or fax number noted below and at the end of the form. Mail to: The Great-West Life Assurance Company Drug Services PO Box 6000 Winnipeg MB R3C 3A5 Canada M6453()-10/12 Fax to: The Great-West Life Assurance Company Fax 1.204.946.7664 Attention: Drug Services The Great-West Life Assurance Company, all rights reserved. Any modification of this document without the express written consent of Great-West Life is strictly prohibited. R.

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