|Classification / Identification:|
| ||Form Number:||5126E||Edition date: ||2019/09 |
| ||Title:||Ontario Seniors Dental Care Program Application Through Guarantor|
| ||Ministry:||Health|| || |
| ||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 do not have a valid Social Insurance Number (SIN) and/or if you have not filed your Personal Tax Return(s) with Canada Revenue Agency (CRA) for the most recent tax year. 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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