[Section 1 - Health] Information - [ For Life/AD&D ...
Metropolitan Life Insurance Company, New York, NY 10166 ENROLLMENT • CHANGE FORM. GROUP CUSTOMER INFORMATION (To be Completed by the Recordkeeper) Name of Group Customer/Employer. Lafourche Parish School Board. Group Customer # 223950 Report # 223950 Sub Code. 0001 Branch. 0001 Date of Hire (MM/DD/YYYY) Coverage Effective Date (MM/DD/YYYY) ................
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