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EMPIRE BLUE CROSS AND BLUE SHIELD Tax I'd Number: Payee Name: Copy of check or deposit slip is REQUIRED for setup CHECK 1 OR 2 AND COMPLETE BANKING INFORMATION. () () 1. SAVINGS (ATTACH DEPOSIT ADVICE
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Anformm blue cross and is a form used for reporting information about health coverage provided by an employer.
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Information such as the employer's name, EIN, and contact information, as well as details about the health coverage provided.
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