Fillable Employer/Consortium Certification of Group ... - PERSI - Idaho - persi idaho

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Employer/Consortium Certification of Group Insurance Policy Purpose of the Form 1 2 3 4 5 Use this form to certify eligibility of a group insurance policy for payment of retirees' premiums by PERSI. Complete the form in blue or black ink. Read "About the PERSI Unused Sick Leave Program", below. Complete the Employer/Consortium Information section and indicate eligibility status for payment of premiums...
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