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GROUP INSURANCE The Prudential Insurance Company of America Employer:Mail the completed form to:Group Contract No.(s):The Prudential Insurance Company of America Group Medical Underwriting, P.O. Box

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How to fill out or fax the completed

1. To fill out the form, start by providing your personal information such as name, address, and contact details.
2. Next, carefully review the instructions mentioned on the form to ensure you understand the requirements.
3. Once you have understood the instructions, proceed to fill in all the required fields in the form accurately.
4. If there are any optional fields, you can choose to fill them out as well.
5. After completing the form, double-check all the information provided for any errors or omissions.
6. If you are faxing the completed form, make sure you have access to a fax machine or an online fax service.
7. Prepare the form by neatly folding it and removing any staples or paper clips.
8. Ensure the fax number is correctly dialed or entered into the online fax service.
9. Place the completed form into the fax machine's document feeder or upload it to the online fax service.
10. Initiate the fax transmission and wait for confirmation that the fax was successfully sent.
11. Keep a copy of the completed form for your records.

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1. Anyone who needs to submit a completed form can either fill it out or fax it.
2. Individuals applying for various government services may need to fill out and submit completed forms.
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What is or fax the completed?

The completed form must be either filed online or faxed to the designated fax number.

Who is required to file or fax the completed?

All individuals who meet the criteria outlined in the instructions must file or fax the completed form.

How to fill out or fax the completed?

The form can be filled out either online or by hand, and then submitted by fax to the designated number.

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The purpose of filing or faxing the completed form is to ensure accurate record-keeping and compliance with regulations.

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The completed form must include all relevant personal and financial information as requested.