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COBRA CONTINUATION COVERAGE ELECTION FORM (Refer to Instructions Attached to This Form) 700 Bishop St. Ste. 700 Honolulu, HI 96813SECTION I Notification (To be completed by the Employer/Plan Administrator)

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What is refer to instructions attached?

Refer to instructions attached refers to following additional guidance or steps provided in a separate document.

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The individual or entity specified in the document must file refer to instructions attached.

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To fill out refer to instructions attached, carefully read and follow the steps outlined in the attached document.

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The purpose of refer to instructions attached is to provide detailed guidance on how to complete a specific task or document.

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The information that must be reported on refer to instructions attached will be specified in the attached document.

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