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Stephen C. Kim, DDS Raymond M. Fujiyama, DDS PATIENT INFORMATION FOR PATIENTS UNDER 18 YEARS OF AGE Date Patients name LastFirstMiddleAddress StreetCityZipNickname Birthdate Social Security # School
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01
To fill out insured's name, you need to provide their first name, middle name (if any), and last name. Write the complete name in the respective fields.
02
To fill out insured's social, you need to enter their social security number. It should be a nine-digit number without any spaces or dashes.
03
Ensure the information is accurate and matches the insured's legal documents.

Who needs insureds name insureds social?

01
Insured's name and social are required by insurance companies, government agencies, and financial institutions when enrolling for insurance plans, applying for loans, or accessing certain benefits.
02
Employers may also need this information for employee benefits or payroll purposes.
03
Any individual or organization requesting insurance coverage or processing personal information may ask for insured's name and social.
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The insured's name and social refer to the legal name of the individual or entity covered by an insurance policy and their Social Security Number (SSN) or Tax Identification Number (TIN).
Insurance companies and employers are typically required to file the insured's name and social when reporting insurance information to the IRS or other regulatory agencies.
To fill out the insured's name and social, provide the legal name exactly as it appears on government documents and enter the SSN or TIN in the designated field on forms such as tax documents or insurance claims.
The purpose of providing the insured's name and social is for identification, reporting income, underwriting, and ensuring compliance with tax laws and regulations.
Information that must be reported includes the insured's full legal name, Social Security Number or Tax Identification Number, and any relevant insurance policy details.
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