Coverage Selection Partnership - Connecticut 2026

1. Click ‘Get Form’ to open the Coverage Selection Partnership - Connecticut in the editor.
2. Begin by entering the name of your partnership in the designated field, ensuring accuracy for official records.
3. Fill in the complete address of the partnership, including city and state, to provide a clear location reference.
4. Indicate the total number of partners by entering the count in the specified field.
5. List each partner's name and social security number. If there are more than four partners, attach additional sheets as necessary.
6. Select one of the options regarding coverage election: either electing exclusion from coverage or revoking a previous exclusion. Make sure to check the appropriate box.
7. Complete the affirmation section by entering the date and obtaining signatures from all listed partners along with their social security numbers.

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