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Adobe PDF   Annual Deductible Re-Assessment Request - 2019The file you are about to download will ONLY work properly if opened with an Adobe Reader 10 or later client. Please do not open this file in a browser.Fill & Print1375.0 kb

Form Classification
Classification / Identification:
 Form Number:014-4931-87EEdition date: 2019/07 
 Title:Annual Deductible Re-Assessment Request
 Ministry:Health and Long-Term Care  
 Branch/ABC:Drug Programs Delivery Branch  
 Program:Ontario Drug Benefit  
 Purpose of Form:MOHLTC form for Trillium Drug Program (TDP) Households to request a re-assessment of their TDP Household's deductible.  

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