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SECTION 2Accompanying person (if applicable)Last Name:
Address:First Name:Civic No. Telephone:StreetCityProvincePostal Coded you have to travel 200 kilometers
or more to receive health care
and services?
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01
Visit the website or office where the eligibility form is available.
02
Read the instructions carefully before filling out the form.
03
Provide accurate and detailed information about your personal and financial situation.
04
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05
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Who needs you may be eligible?
01
Individuals seeking financial assistance or benefits.
02
People looking to qualify for specific programs or services.
03
Those who meet certain criteria but need to prove their eligibility.
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You may be eligible refers to the specific criteria or qualifications that an individual must meet in order to qualify for a particular benefit or program.
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