Follow the steps to complete your form accurately.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the 'Plan Member Information' section. Enter your contract number and member ID number. Fill in your last name, first name, and date of birth in the specified format (yyyy-mm-dd). Provide your complete address, including apartment or suite number, street number and name, city, postal code, and province. Also, select your preferred language of correspondence by checking the appropriate box.
3. Fill in your daytime phone number. Then, proceed to the 'Claimant Information' section. Here, provide the claimant's last name, first name, and date of birth, again in the format of yyyy-mm-dd. Indicate the relationship of the claimant to the plan member by marking the appropriate option (self, spouse, or child).
4. List the drug names and their corresponding Drug Identification Numbers (DIN) as required. You may need to enter multiple drugs if applicable.
5. Indicate whether the claimant has recently been approved as part of the program or if their application was denied within the past 12 months. Fill in the relevant date fields as necessary.
6. In the 'Additional Information' section, review and certify the truthfulness of the information provided. Grant authorization for Sun Life Assurance Company to manage your personal information as outlined.
7. Sign and date the form. Ensure your signature is clearly marked, and the date is entered in the required format (yyyy-mm-dd).
8. Finally, save any changes made to your completed form. You can download it for your records, print a copy, or share it as required.

Begin completing your documents online today for a seamless experience.