Get Healthy Smiles, Clear Vision-application Form - Pxw1 Snb

The Healthy Smiles, Clear Vision-Application Form - Pxw1 Snb is a vital document for families seeking dental and vision coverage for children aged 18 years and under. This guide will walk you through the process of filling out the application form online, ensuring you provide all necessary information accurately.

Follow the steps to successfully complete your application.

1. Click the ‘Get Form’ button to access the application document, which will open in your editing environment.
2. Begin filling out Part I – Eligibility Criteria. Confirm that your family meets the requirements, including residency in New Brunswick and lack of other dental or vision insurance.
3. In Part II – Health Insurance Coverage, indicate whether you or your family members have existing health insurance. If so, provide the insurer's name and policy number.
4. Proceed to Part III – Parent/Guardian Information. Enter your name, contact details, and mailing address. Make sure to include information about each dependent child, ensuring you attach copies of their identification as specified.
5. For Part IV – Total Annual Net Income, provide necessary financial documents such as the previous year’s New Brunswick Income Tax return or Notice of Assessment for yourself and your partner, if applicable.
6. Complete Part V – Declaration and Consent. Read the declaration carefully, then print your name and sign, along with the signature of your partner if applicable. Make sure to note the date of completion.
7. Review all entered information for accuracy and completeness before saving changes. You can then download, print, or share the completed form as needed.

Start completing the Healthy Smiles, Clear Vision-Application Form online to secure your child's coverage.