You will need to indicate your full employer name and number and their contact information. Please refer to Notice 7 for requirements for this information.
Your name, address, current work telephone number, and type of Insurance and the date and reason they are providing the above information may be used for employment related purposes by the employer, insurance agents and insurance carriers. To obtain proof of employment from an insurance agent, please contact the insurance agents' trade group in your State or local jurisdiction to confirm this information. If you do not know the name of the insurance agent and the insurance group, you may use a contact number for this insurance agent or insurance group.
Get the free SCHOOL SPECIALTY , INC. Benefit Election Form Long ... - Unum
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Underwritten by: UNM Life Insurance Company of America LTC Department 2211 Congress Street, Portland, Maine 04122 SCHOOL SPECIALTY, INC. Benefit Election Form Long Term Care Policy #931976 Date of
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