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Group Subscription Certificate (This Subscription Certificate also applies to Small Business) (Rev. 4/10)M150013F Rev. 4/10Updated 7/15GEISINGER HEALTH PLAN 100 North Academy Avenue Danville, PA 178223220 HEALTH

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What is this subscription certificate?

This subscription certificate is a document that confirms the subscription of shares in a corporation.

Who is required to file this subscription certificate?

Shareholders who have subscribed to shares in a corporation are required to file this subscription certificate.

How to fill out this subscription certificate?

The subscription certificate must be filled out by providing information such as the shareholder's name, number of shares subscribed, and date of subscription.

What is the purpose of this subscription certificate?

The purpose of this subscription certificate is to officially document the subscription of shares by a shareholder in a corporation.

What information must be reported on this subscription certificate?

The subscription certificate must include the shareholder's name, number of shares subscribed, date of subscription, and signature.

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