Employee Details:
Use mailing address to send refunds to (cheque method)
Authorization and Confirmation:
Note: The act of inputting your name below serves as a general electronic signature and is legally binding. Please read the applicable statements below:
- Plan Administrator / Employee: I acknowledge (by typing my name below) that the information contained in this application is accurate and true to my knowledge.
- Plan Administrator: I have the permission of the Employee to share the information and that the Employee was informed and is eligible to participate in the Smartin Benefits Plan.
- Employee: I confirm participation and eligibility to participate in the Smartin Benefits Plan.