Health & Dental Online Sign-up
Health Trust
Manulife Health and Dental
Enroll in Health Trust
Company Name:
Address:
City:
Province:
AB
BC
MB
NB
NF
NS
NT
NU
ON
PE
SK
YT
Postal Code:
Key Contact Information:
(this person will be the main contact person for your
Health Trust
account)
Salutation:
Dr.
Mr.
Ms.
Mrs.
Ms.
First Name:
Last Name:
Telephone:
Fax:
Email:
Enrollment Details:
Effective Date:
How would you like to receive your Registration documents?
Email
Fax
Mail
How would you like to receive your Invoices?
Email
Fax
Mail
How will payments be made to Hub Financial?
Select...
Cheque
Direct Banking
All employee claims will be paid by Electronic Funds Transfer (EFT).
Click
here
for the enrollment form.
Would you like to use the Internet to manage your Account?
Yes
No
Were you referred by a licensed Broker?
Yes
No
If yes, Broker Name:
Telephone: