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REVOCABLE AUTHORIZATION Please complete and return this authorization form to ensure that your Health & Welfare Benefit coverage is not interrupted. We must receive your authorization as soon as possible.
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Revocable authorization is a legal document granting permission that can be revoked or canceled at any time by the person who issued it.
Individuals or entities who want to grant permission that can be revoked at any time are required to file revocable authorization.
Revocable authorization can be filled out by providing specific details about the permission being granted and clearly stating that it can be revoked at any time.
The purpose of revocable authorization is to grant temporary permission that can be canceled or revoked at any time as needed.
The information reported on revocable authorization must include details about the permission granted, the parties involved, and the conditions under which it can be revoked.
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