IBA PHSP Registration Form

Section A - General Information

Name of corporation, partnership or sole proprietor
Effective date when coverage begins under the plan
Fiscal month when the business year ends
Calendar month when annual coverage renews
* More information is required if not incorporated

Annual Benefit Coverage Limits by Category
* If no limits are specified, the default will be 'Unlimited'

Section B - PHSP Terms (Please read carefully)

* Select PHSP Terms to toggle between showing and hiding the detail.


Section C - Registration Fee

The total fee due with this registration is $ CAD.

Note: This registration fee is tax exempt and there are no annual renewal fees.

Employees (Plan Members) can be added or their relevant information updated via our PHSP Claim form.

We use Interac e-Transfer to accept payment for the Registration Fee due, which is a very convenient and secure payment method. Since we are registered for Autodeposit, there is no security question required.

Just login to your business financial institution and use the Interac e-Transfer option to send the payment to:

Name: INTENDO BENEFITS
Email Address: benefits@intendo.ca

* Your payment will be matched with your registration based on your business name.

Also remember to select the option to add us as a recipient to your Payee List to facilitate future payments for claims.

Section D - Authorization

Recording my name below serves as a legally binding electronic signature and confirms that:
1. All information provided in this form is accurate and true to my knowledge.
2. I am authorized to act on behalf of the Plan Owner identified in Section A.
3. I have read and agree to the PHSP Terms listed in Section B.
4. I agree to paying the applicable registration fee listed in Section C.