|Classification / Identification:|
| ||Form Number:||5125E||Edition date: ||2019/09 |
| ||Title:||Ontario Seniors Dental Care Program Application|
| ||Ministry:||Health and Long-Term Care|| || |
| ||Branch/ABC:||Health Promotion|| || |
| ||Program:||Health Promotion|| || |
| ||Purpose of Form:||You may use this application form to apply for the Ontario Seniors Dental Care Program if you and your spouse (if applicable) have filed your Personal Tax Return(s) with Canada Revenue Agency (CRA) for the most recent tax year and have a valid Social Insurance Number (SIN). If you have a spouse (married or common law partner) who would also like to apply for the Program, they must complete their own application form.|| || |
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