CE AND SUPPLEMENTARY BENEFITS PA APPLICANT INFORMATION APPLICANT LEGAL LAST NAME APPLICANT LEGAL FIRST NAME PERSONAL HEALTH NUMBER (PHN) BIRTHDATE (MM / DD / YYYY) APPLICANT LEGAL SECOND NAME DAYTIME TELEPHONE NUMBER MAILING ADDRESS: APT / UNIT STREET NUMBER STREET NAME CITY PROVINCE POSTAL CODE FINANCIAL INFORMATION You must file your income tax return with the Canada Revenue Agency (CRA) by April 30 each year. Failure to file your income tax return may impact your eligib.
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How to fill out the Canada HLTH 119 online
Filling out the Canada HLTH 119 form online can streamline your application for premium assistance and supplementary benefits. This comprehensive guide will walk you through each section to ensure a smooth and successful submission.
Follow the steps to complete your form effectively.
- Press the ‘Get Form’ button to retrieve the form and open it in your preferred editor.
- Begin with the applicant information section. Enter your legal last name, first name, personal health number (PHN), and birthdate formatted as MM/DD/YYYY. If applicable, include your legal second name and daytime telephone number.
- Proceed to the financial information section. Ensure you have your income tax return filed with the Canada Revenue Agency (CRA) by April 30 to maintain eligibility for premium assistance. Record the tax year and your net income from your Notice of Assessment or Notice of Reassessment.
- Calculate your total net income by adding your net income and your spouse’s net income. Document details for deductions based on age and disability, ensuring accurate calculations.
- Finalize the form by reading and signing the declaration and consent section. Ensure you or your spouse sign the application as required before submission.
Begin your application process today by completing the form online.
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