As a member of the OPPA group benefits program I understand personal information about me, my partner and my child(ren), if applicable, is relevant for the administration of my/our benefits. I am authorized by my dependants to disclose their personal information relevant for the administration of benefits and payment of claims. I authorize Target Benefit Administrators and Williams Leal & Vito to collect my personal information and maintain my personal and confidential record that can only be shared with third party service providers for the purpose of assessing and administrating claim made by me, my dependants or my beneficiary.