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NATIONAL HEALTH INSURANCE APPLICATION FOR RETURN OF CONTRIBUTIONS Former INSTRUCTIONS Please use block letters. A copy of the certificate issued by the employer detailing total earnings paid and total
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This form is a sample health insurance form provided by www.sampleforms.com for reference purposes.
Health insurance companies or individuals who have health insurance coverage are required to fill out this form.
The form can be filled out online or printed and filled out manually following the instructions provided on the form.
The purpose of this form is to gather information about an individual's health insurance coverage for reporting and compliance purposes.
The form requires information such as the policy number, coverage period, premium amount, and details of the insured individual.
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