Fillable long term disability medical sample invoice form

Description
Brit Emunah A Covenant of Trust LONG TERM DISABILITY INVOICE RETURN THIS INVOICE ALONG WITH A CHECK FOR THE FULL PREMIUM DUE TO THE RPB OFFICE BY: 01/01/2012 The Annual Premium rate for the 180 Day Benefit Waiting Period is $4.80 per $1,000 of salary. The Annual Premium rate for the 90 Day Benefit Waiting Period is $5.44 per $1,000 of salary. COVERAGE TERM: 01/01/2012 THROUGH 12/31/2012 THE MAXIMUM SALARY COVERED...
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long term disability medical sample invoice
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