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If you live outside Quebec Manulife Financial Group Benefits Health Claims PO BOX 1653 WATERLOO ON N2J 4W1 If you live in Quebec PO BOX 2580 STATION B MONTREAL QC H3B 5C6. Were contact lenses prescribed for severe corneal astigmatism keratoconus or aphakia Can visual acuity be improved by at least 2 lines on the Snellen chart over the best possible vision with glasses Could visual acuity be improved up to at least the 20/40 level by glasses Signature of supplier Date signed dd/mmm/yyyy Total...

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