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Get and Sign Manulifecomengineerscanadatl Form

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Permanent full-time employee of Association Name of Prov./Terr. Assoc. o Limited Licensee o Member in Training Membership No. (If applying for spouse’s coverage) Name of Spouse (PLEASE PRINT) Male o Female o First Last Spouse’s Date of Birth (DD/MM/YY) Non-smoker* o Smoker o Birthplace: Country Tel. Bus.: ( Spouse’s Occupation (If self-employed, please describe nature of business and duties) ) *Non-smoker rates apply to people who have not smoked cigarettes in the last 12 months...
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