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Enter the appropriate data in the space Information about you be sure, Contract number, Member ID number, Your plan sponsoremployer, Your last name, First name, Your address street number and name, Apartment or suite, City, Preferred language of, m Male m Female, Date of birth yyyymmdd Province, Daytime phone number Postal code, Spouse and children covered by, and Spouses last name.
It is necessary to write down certain data in the segment Details of claim, If the cost of your treatment will, If Yes date teeth were extracted, Where did the accident occur m, How did the accident occur, Reason for replacement, Please include the following to, Pretreatment xrays for crowns, and Authorization and signature you.
In the section Authorization and signature you, Date yyyymmdd, Mailing instructions keep a copy, Sun Life Assurance Company of, Sun Life Assurance Company of, Page of DENTHSAE, and For SLF use DCF, identify the rights and obligations.
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