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Financial, Group Benefits, Plan Member Administration, PO BOX 1627, WATERLOO ON N2J 4P4 1 Plan Sponsor statement Enter your certificate number if known. Otherwise leave blank for Manulife Financial to complete. Plan number Account/Division number Billing division (if applicable) Certificate number Plan Sponsor name Provide permanent full time hire date (dd/mmm/yyyy) If a re-hire, provide the date previous employment ended (dd/mmm/yyyy) Does the waiting period apply to this application?.

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