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ABRAHAM & MONSOON ACADEMY 20162017 423 Main Street, Abraham, MA 01095 Phone: 413.596.6811 Fax: 413.596.3655 www.wma.us STUDENT ACCIDENT & SICKNESS INSURANCE PLAN STUDENT Date of Birth First Name Middle
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This document is a form for reporting student accident and sickness insurance for the academic year 2016-17.
Educational institutions and insurance providers are required to file studentaccidentsicknessinsurance2016-17 dlrdocx - wma.
The form must be filled out with accurate information regarding student accident and sickness insurance coverage for the specified academic year.
The purpose of this form is to ensure that educational institutions have appropriate insurance coverage for students in case of accidents or sickness during the academic year.
Information such as insurance policy details, coverage limits, and contact information for the insurance provider must be reported on studentaccidentsicknessinsurance2016-17 dlrdocx - wma.
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