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Delta Dental Individual and FamilySMENROLLMENT FORM
The effective date of your individual dental plan will be the first of the month following receipt of this completed
enrollment form and payment,
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What is form effective date of?
Form effective date refers to the date on which a form becomes valid or active.
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Any individual or entity who is submitting a form that requires an effective date must fill out the form effective date section.
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The only information required on the form effective date is the actual date that the form should become effective.
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