Adding or Deleting Dependents

1. Plan Administrator completes Sections 1 and 3 to 6 of the Notice of Change Form by indicating the Plan Member's identification number, name, effective date of change etc.
2. Plan Member completes applicable information in Sections 2 and 7 to 13 of the Notice of Change Form
3. Fax a copy of this form to your nearest Morneau Shepell office
4. Retain the original for your files