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Sharp Health Plan Medicare
Bank Withdrawal PreAuthorization Form
Name of Account Holder:
Name of Member (If different from Account Holder):ID Number:Bank Name:Account Type: o Checking o SavingsBank
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What is name of member if?
The name of member if is a section on a document that requires the identification of the member.
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The individual or entity responsible for filing the document is required to provide the name of the member if.
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The name of the member should be clearly written in the designated section of the document.
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The purpose of including the name of the member is to identify the individual or entity associated with the document.
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The name of the member must be reported accurately without any errors or omissions.
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