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Get Canada Pension Disability Form 2005-2024

Ian s Statement For Disability Benefits Policy and Certificate No. TO ALLOW US TO MAKE AN ASSESSMENT OF YOUR PATIENT S CLAIM IT IS IMPERATIVE THAT YOU ANSWER ALL OF THE QUESTIONS IN FULL. Part 1: Patient Authorization Name Date of Birth (day, month, year) I hereby authorize and request all medical practitioners who may have attended me and all hospitals, government authorities, pension boards, employers or other persons to furnish The Canada Life Assurance Company or its accredited rep.

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