MSP Application for Group Enrolment Form
Information Needed to Complete the Form
In addition to the Member’s personal information, additional information is required to complete the form, including:
- Group number (4823381), which is pre-printed on the form,
- Detailed information on your dependents,
- Residency information,
- Signatures from both the Member’s and spouse.
Additional information to complete the form is listed on the second page of the form. Please follow the instructions on the form.