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For Quebec applicants I request that this form be in English. Je demande que ce formulaire me soit remis en anglais. Dependant Information Complete this section if the plan includes health and/or dental coverage and you have not refused such coverage for your dependants in section 3. I hereby make the above beneficiary designation Revocable I may change this beneficiary designation at any time If designating a beneficiary who is a minor or who lacks legal capacity you may wish to appoint a...

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