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OMB No. 09381378 Expires: 12/31/2026Exhibit 1: MODEL INDIVIDUAL ENROLLMENT REQUEST FORM TO ENROLL IN A MEDICARE ADVANTAGE PLAN (PART C) Who can use this form?People with Medicare who want to join

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How to fill out expires 12312026

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Locate the expiration date field on the form or document.

02

Enter the month portion: 12 for December.

03

Enter the day portion: 31 for the last day of the month.

04

Enter the year portion: 2026.

05

Double-check the entire date entry: It should read '12/31/2026'.

06

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What is expires 12312026?

Expires 12312026 refers to a specific expiration date for a document or product, indicating that it will no longer be valid after December 31, 2026.

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Individuals or entities that are involved with the document or product that expires on December 31, 2026, may be required to file any necessary paperwork before this expiration date.

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The purpose of expires 12312026 is to clearly communicate the end date of validity for a document or product, ensuring compliance with regulations and avoiding potential penalties for continued use beyond this date.

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Information that must be reported may include the name of the filer, details of the document or product, date of filing, and any specific compliance data required by relevant authorities.

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