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Comprehensive/ Exam (Group # 186-1) Materials Only (Group # 186-2) Check One: New Application for Coverage Change Authorization Waiver of Coverage (complete Section (4) ONLY) Enrollment/Change Form-VISION

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How to fill out surency enrollment form

How to fill out Surency enrollment form:

01

Start by gathering all the necessary information and documents required for the enrollment form. This may include personal details, contact information, and any relevant supporting documentation.

02

Carefully read through the form and follow the instructions provided. Ensure that you understand all the questions and sections before proceeding.

03

Begin filling out the form by providing your personal information such as your full name, date of birth, social security number, and address. Double-check the accuracy of the information filled in.

04

Move on to the next section which might require you to provide details about your current employer or insurance provider.

05

If applicable, fill out the section related to your dependents, including their names, dates of birth, and relationship to you.

06

Make sure to review the form once again before submitting. Look for any errors or missing information that needs to be completed.

07

Finally, sign and date the enrollment form as instructed. If required, include any additional documentation or signatures from authorized individuals.

Who needs Surency enrollment form:

01

Individuals who are seeking to enroll in a Surency insurance plan may need to fill out the enrollment form. This could include employees at a company offering Surency insurance or individuals interested in purchasing a Surency insurance policy.

02

Those who have experienced a qualifying life event, such as getting married or having a child, may also need to fill out a Surency enrollment form to update their coverage or add dependents.

03

Anyone who wishes to make changes to their current Surency insurance plan, such as switching plans or adding additional coverage, may be required to complete an enrollment form.

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