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Application for Medicare Supplement InsuranceNational Health Insurance Company PO Box 95464, Cleveland, OH 44101 Toll free telephone: (888) 9662345 www.natgenhealth.com Fax: (888) 3443232 New Business

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Start by writing the month in two digits, for example, January is 01.

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Next, write the day in two digits, for example, the 5th of the month is written as 05.

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MMDDYYYY is a placeholder for a specific date format in month-day-year.

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