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Enrollment FORM FOR MODULAR PLANS La Capital Insurance and Financial Services Inc. GROUP NO.EMPLOYER NO.IDENTIFICATION NO.625 Maintainable St, PO Box 1500, Quebec QC G1K 8×9 Telephone: 1 855 7477819

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www.lacapitale.com/filesliveclaim - La Capitale is an online platform for filing claims and accessing insurance information with La Capitale.

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