Group Health: Delete an employee

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Please provide information about the change you wish to make

Business Name:

What is the date you want this change to be effective: *

Please provide information about the employee you wish to delete

First name: *

Middle initial:

Last name: *

Gender: *

Male

Female

Date of birth: *

Comments or additional information:

Customer name or code: %profile[profile_unique_cid]

Thanks for providing this information %profile[profile_first_name]. If we need to contact you for additional information, we will send you a message through the secure Message Center. You can view a copy of this request by clicking on File Cabinet. You will receive an email confirming this request made on Monday, February 6, 2012 - 2:15am.

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"My son recommended me to Keller-Brown and I’ve been a customer for 8 years. I’m so happy to be a customer. I’m very satisfied with the service at Keller-Brown. I’m originally from Poland and English is my second language. My agent was very helpful and patient.” Maria Mudry, Shrewsbury, PA

Disclaimer

Statements on this website as to policies and coverages and other content provide general information only. Please contact our office at (717) 235-6891 to discuss specific coverage details and your insurance needs. No binder, insurance policy, change, addition, and/or deletion to insurance coverage goes into effect unless and until confirmed directly with a licensed agent. Note any proposal of insurance we may present to you will be based upon the values developed and exposures to loss disclosed to us on this online form/application and/or in communication with us. All coverages are subject to the terms, conditions and exclusions of the actual policy issued. Not all policies or coverages are available in every state.

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Please provide information about the change you wish to make

Please provide information about the employee you wish to delete

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