Submission date: Oct.

10, 2023

POOJA ARORA
8713 5 AVE SW
EDMONTON, Alberta
T6X 1E2

Summary - Online claim submission

Plan member: POOJA ARORA
Plan number: 57318
Member ID (or certificate number): E000121447
Confirmation number: 091023-240061-00

Claim Details - Massage therapist

Service date Service type Visit type Total charge
03 OCT 2023 Initial visit Provider's office $105.00
Total charge: $105.00

1
 Submission date: Oct. 10, 2023

POOJA ARORA
8713 5 AVE SW
EDMONTON, Alberta
T6X 1E2

Summary - Online claim submission

Continued from previous page

Provider: KASSANDRA MCPHERSON

Patient: POOJA ARORA
Number of claim documents added: 1
Are you covered for this claim type (Massage therapist) under another
benefits plan? Let’s coordinate your benefits between the 2 plans. No
Is this claim related to an accident or injury? No
Did you get a doctor’s referral or prescription for this expense? No

2
 Submission date: Oct. 10, 2023

POOJA ARORA
8713 5 AVE SW
EDMONTON, Alberta
T6X 1E2

Summary - Online claim submission

Continued from previous page

I certify that the information provided is true, correct and complete to the best of my knowledge. I certify that all
goods and services being claimed have been received by me, my spouse and/or my dependants.

The submission of fraudulent claims is a criminal offence. Canada Life takes the submission of
fraudulent claims seriously. Suspected fraudulent claims may be reported to your employer or plan
sponsor and to the appropriate law enforcement agency.

You must keep all your receipts and supporting documentation for 2 years in case your claim is audited.

By submitting this claim, I agree to the online claim terms and conditions, and I agree to the collection, use and
disclosure of personal information as set out in the Privacy guidelines. This includes the administration of my
products or services and to help us analyze and optimize customer service and business processes. Personal
information may be disclosed to service providers and others referred to in the Privacy guidelines, where
required to administer products or services.

On the web Mailing address Telephone

Visit us at our personalized secure Winnipeg Benefit Payments 1-800-957-9777

service site for plan members at P.O. Box 3050 Station Main
canadalife.com Winnipeg, Manitoba
R3C 0E6