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DE 945 ANNUAL INCOME REPORT FOR
DISABILITY INSURANCE ELECTIVE COVERAGE
THIS IS NOT A BILL
BEARER ENDED
DIED Account NumberSocial Security Number
DEPT. USE ONLY DO NOT ALTER THIS AREAEFFECTIVE
DATE
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What is do not alter this?
Do not alter this is a document that should not be changed or modified.
Who is required to file do not alter this?
Only specific individuals or entities are required to file do not alter this.
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To fill out do not alter this, you must provide the requested information accurately and completely.
What is the purpose of do not alter this?
The purpose of do not alter this is to ensure the integrity and authenticity of the document.
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Specific information related to the document must be reported on do not alter this.
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