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FORM D INTENTION TO OBTAIN ALTERNATE COVERAGE (Service Manager Waiver LCS only) For the period November 1, 2015, November 1, 2016, This form is to be filled in by the CAN of the Service Manager or
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Start by clearly stating your intention or purpose for filling out the form.
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Provide the necessary personal information such as your name, address, and contact details.
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Indicate the date and place where you are filling out the form.
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Specify the relevant details regarding the intention, such as the reason behind it and any supporting documents if required.
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Review the form for accuracy and completeness before submitting it.

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