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THE UNIVERSITY OF BRITISH COLUMBIA NEWBORN/ADOPTION Enrollment FORM FOR GROUP MEDICAL AND DENTAL COVERAGES Personal information provided on this form is collected pursuant to section 26 of the Freedom

If you are a UBC Student/Employee, please see Benefits Info and click HERE: Benefits Info If you are a University employee or employee of another institution, you do not need to complete this form and access your benefits. Your benefits will be administered by UBC's Benefits Services Office (see below for more information on UBC benefits). Contact Questions regarding the University of British Columbia's health insurance system and policies should be directed to the University of British Columbia's Benefits Services Office: If you are a UBC Student/Employee, please see Benefits Info and click HERE: Benefits Info If you are a UBC employee or employee of another institution, you do not need to complete this form and access your benefits. Your benefits will be administered by UBC's Benefits Services Office (see below for more information on UBC benefits). Contact Questions regarding the University of British Columbia's health insurance system and policies should be directed to the University of British Columbia's Benefits Services Office: benefits.ca Email with any questions. Contact Information for the UBC Urological Clinic Medical Clinic Office of Employee Benefits 200 – 200 East Mall Drive Vancouver, BC Canada V5Z 3N9 Phone: Email: mccorleyubc.ca Medical Clinic Office of Employee Benefits 200 – 200 East Mall Drive Vancouver, BC Canada V5Z 3N9 Benefits Services University of British Columbia Benefits Services 1st Floor 1315 Nelson Street Vancouver, BC Canada V5T 6W5 Phone: Fax: Email: benefits.

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