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GENERAL CLAIM SUBMISSION FORM SECTION 1 PLAN MEMBER INFORMATION GREEN SHIELD CANADA ID NUMBER EMAIL ADDRESS SURNAME FIRST NAME PHONE NUMBER ADDRESS COMPANY NAME CITY PROVINCE POSTAL CODE SECTION 2

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What is general claim submission form?

The general claim submission form is a document used to report and submit a claim for reimbursement or compensation.

Who is required to file general claim submission form?

Any individual or organization that is seeking reimbursement or compensation for a claim is required to file the general claim submission form.

How to fill out general claim submission form?

To fill out the general claim submission form, you need to provide information such as your personal or organizational details, the nature of the claim, supporting documents, and any other required information as specified on the form.

What is the purpose of general claim submission form?

The general claim submission form serves the purpose of documenting and reporting a claim for reimbursement or compensation.

What information must be reported on general claim submission form?

The general claim submission form requires you to report information such as your personal or organizational details, the nature and details of the claim, supporting documents, and any other requested information as specified on the form.

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