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Head Office One West mount Road North P.O. Box 1603 STN. Waterloo, Waterloo Ontario N2J 4C7 TF 1.800.265.4556 Fax 519.883.7403 STATEMENT OF HEALTH FOR GROUP INSURANCE COMPLETION OF THE APPLICATION
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This application includes forms for reporting annual income.
Individuals and businesses with taxable income are required to file this application.
The application can be filled out online or by mailing in the completed forms.
The purpose of this application is to report taxable income for the year.
Income sources, deductions, and tax credits must be reported on this application.
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