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Manlike Financial, P.O. Box 1650, Waterloo, Ontario N2J 4P5
For more than 2 or 3 claims per year, you will be required to submit all forms. However, for the first year only, you will be required to submit only one form per request for any group (e.g. health and dental, vision). For subsequent years, you will be required to submit all 3 forms.
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Group Benefits Request for Over-Age Dependent Coverage (Complete sections 1, 2, 3 and 5) Termination of Over-Age Dependent Coverage (Complete sections 1, 4 and 5) Please complete form and send to
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