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CITY OF LINCOLN PARK ENROLLMENT/WAIVER OF COVERAGE FORM FOR PLAN YEAR JULY 1, 2022, JUNE 30, 2023, Employee Information Name (first, middle initial, last)Social Security NumberMailing Address (Street)
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How to fill out new benefit enrolment forms
How to fill out new benefit enrolment forms
01
Read all instructions carefully before filling out the form.
02
Provide accurate and up-to-date personal information, such as full name, address, and social security number.
03
Select the benefits you wish to enroll in and indicate any dependents or beneficiaries if applicable.
04
Double-check all entries for errors or missing information before submitting the form.
05
Sign and date the form where required and keep a copy for your records.
Who needs new benefit enrolment forms?
01
Employees who are eligible for benefits offered by their employer.
02
Individuals who are enrolling in new benefit programs or making changes to their current benefits.
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What is new benefit enrolment forms?
New benefit enrolment forms are documents used to enroll in new benefits offered by a company or organization.
Who is required to file new benefit enrolment forms?
All employees who are eligible for new benefits are required to file new benefit enrolment forms.
How to fill out new benefit enrolment forms?
New benefit enrolment forms can be filled out either electronically or by hand, following the instructions provided by the company or organization offering the benefits.
What is the purpose of new benefit enrolment forms?
The purpose of new benefit enrolment forms is to gather information from employees who wish to enroll in new benefits being offered.
What information must be reported on new benefit enrolment forms?
New benefit enrolment forms typically require personal information such as name, address, Social Security number, and benefit selection.
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