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Union Security Insurance Company Mail to Assurant Administrative Office P. O. Box 981624 El Paso Texas 79998-1624 Form 10 12/98 create barcode Page 1 of 2 KC2832A 04/2012 IMPORTANT NOTICE TO APPLICANTS PLEASE READ CAREFULLY My signature on this application certifies that I 1 Apply for the coverages designated for which I am eligible under my employer s plan with Union Security Insurance Company.
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