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Complete the sections indicated below. Remember to sign & date form within 31 days of the qualifying event. GEO RGA DEPARTMENT OF COMMUNITY HEALTH State Health Benefit Plan C h age an n d Miscellaneous
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Locate the designated areas where you are required to sign and date. These sections are usually marked with a line or a signature block.
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Write the current date in the specified format (e.g., MM/DD/YYYY) next to your signature.
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It is important to carefully review the instructions or guidelines provided along with the document to determine who needs to sign and date it.
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