Adding or Deleting Dependents

1. Plan Administrator completes the “Reason for Completion” box and Part 1 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 Section B of the Notice of Change Form
3. Fax a copy of this form to your nearest Morneau Sobeco office
4. Retain the original for your files

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Last updated on:  Friday, September 24, 2004  Page: 

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