Get form 3001

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APPLICATION FOR INSURANCE * UNITED AMERICAN INSURANCE COMPANY A LEGAL RESERVE STOCK COMPANY * ADMINISTRATIVE OFFICE: MCKINNEY, TX ALL POLICIES ARE NOT AVAILABLE IN ALL STATES. COLORADO Payroll Deduction (Frequency) Weekly Bi-Weekly Monthly Semi-Monthly Payroll Deduction Amount Company ID Accident Indemnity Policy UA-250 Cafeteria Plan Yes No Requested Effective Date (mm-dd-yyyy) Accident Employee Only Spouse Only...
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