50625 1008r form 2025

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The document is a Group Member Life & Dental Enrollment Application that collects information from employees regarding their enrollment in various insurance coverages, including dental, life, accidental death and dismemberment (AD&D), and disability. It includes sections for employer and employee details, coverage selections, beneficiary information, and acceptance or refusal of coverage. The application emphasizes the importance of accurate information and outlines the conditions under which coverage may be granted.

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Versions	Form popularity	Fillable & printable
2016	4.2 Satisfied (55 Votes)
2008	4 Satisfied (37 Votes)

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