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Employer Group Benefits Coverage Information
Thank you for choosing The Hartford. All sections of this form must be completed and received by The Hartford within 30 days
of the signature date.
Employers:
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The employers please completely fill form is typically required by employers or companies who are seeking to gather detailed information about potential employees. It allows employers to gather necessary information to assess an individual's qualifications, employment history, education, and other relevant details. It is often used as part of the application or hiring process.
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Employers must report information such as employee wages, tax withholdings, and other relevant details.
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