Get Request For Continuation Of Insurance Form - Special Markets ...

This guide is designed to assist users in completing the Request For Continuation Of Insurance Form for Special Markets online. By following this step-by-step process, you will ensure that all required information is filled out accurately and submitted properly.

Follow the steps to complete your insurance request form online:

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Fill in the retired member information section, including last name, first name, initials, sex, date of birth, school district, and retirement date.
3. Complete the member contact information by entering your street address, city, province, postal code, and telephone numbers.
4. If applicable, provide spouse information by filling out their last name, first name, initials, sex, and date of birth.
5. In the confirmation of benefits section, indicate the types of coverage you wish to continue by selecting the appropriate options.
6. Provide details of the insurance amount you wish to continue for yourself and any spouse or dependents, ensuring compliance with the outlined eligibility criteria.
7. Select your preferred payment option by choosing between pre-authorized debit, credit card payment, or cheque. Fill in the necessary details for your chosen method.
8. Sign the authorization form in ink, providing your printed name, date, and spouse's signature, if applicable.
9. Review all sections of the form for accuracy before saving your changes, and either download or print the completed form.
10. Submit the completed form to the designated address as provided in the instructions.

Complete your Request For Continuation Of Insurance Form online today to ensure coverage without interruption.