Transcription of How to complete this form - gnb.ca
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How to complete this form - gnb.ca
Application for Coveragepage 1 of 4 How to complete this form1. All sections must be completed. Please print clearly. Ensure you (and your spouse if applicable) sign sections 3, 4 and 5. Any dependant (if applicable) over the age of 16 must sign section 5. 2. Only one application form per family is necessary. If you have a spouse and/or dependant(s), they do not need to complete a separate If you are applying for coverage and have an existing drug plan, you must complete the Supporting Application Form Other Drug Coverage and send it along with your completed application form.
4. Mail or fax your completed and signed application to the address/fax number above. 5. Once your application is processed, you will receive notification of your acceptance in the New Brunswick Drug Plan with your premium and copayment details and the effective date of …
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