I declare that my dependent children meet the following requirements:

– children who are under 21 years of age and for whom the member (or spouse) exercises parental authority;

– children who are 25 years of age or younger, who do not have a spouse and who are full-time students at a recognized educational institution.

I have included the required documents in my application, such as a birth certificate and/or a proof of marital status, as well as a proof of education (if applicable).

I understand that, in the event I cancel the addition of dependent coverage after submitting my payment, Major Plan may deduct $25 from my refund as an administration fee.

I understand that payment of the contribution must be received no later than 12 business days after my form is submitted to Plan Major. If applicable, it is my responsibility to anticipate postal and banking delays. I understand that failure to forward my payment within these time frames will result in my application being cancelled without review.

I understand that if I lose my student status or my coverage in the winter session, my dependents will automatically lose their coverage with no possibility of a refund.

I am aware of the terms and conditions as well as the cost of the fee associated with this application and I agree to pay the fee. If in doubt, I have contacted Plan Major.

Please note that it is your responsibility to ensure that you receive confirmation of receipt of your application and payment from Plan Major. Contributions include, if applicable, premiums, administration fees, commissions, financial reserves and taxes that may be associated with the plan.