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Get Canada Toronto PB0060 2007-2024

Proof of Student Status Consent Form Employee last name Employee first name Employee Number Division I name of student authorize the City of Toronto to disclose my student status to Manulife Financial. The purpose of this consent form is to extend the Health and/or Dental coverage to adult student of the above mentioned employee. One of the following is accepted proof of student status 1. copy of the school student identification card bearing the student name current school year and name of the post-secondary institution or 2. 416-392-8098 Metro Hall 55 John Street 13th floor Toronto ON M5V 3C6. PB0060 05/2007 th Mail completed form to Pension Payroll Employee Benefits Division Benefits Employee Services Section Metro Hall 13 floor with proof of student status. letter from the post-secondary institution confirming enrolment for current year Student signature Date The personal information on this form is collected under the authority of the City of Toronto Act 1997 and Schedule A of Chapter 71 and Article X Schedule No* 2 of Chapter 227 of the Municipal Code. The information is used for enrolment purposes and/or changes to benefits coverage. Questions about this collection can be directed to Supervisor Benefits Employee Services telephone no. letter from the post-secondary institution confirming enrolment for current year Student signature Date The personal information on this form is collected under the authority of the City of Toronto Act 1997 and Schedule A of Chapter 71 and Article X Schedule No* 2 of Chapter 227 of the Municipal Code. The information is used for enrolment purposes and/or changes to benefits coverage. Questions about this collection can be directed to Supervisor Benefits Employee Services telephone no. .

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