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Get Vrs 39 Form 2014-2024

Enrollment Application For VRS Optional Group Life Insurance A Minnesota Life Insurance Company - A Securian Company Richmond Branch Office P. O. Box 1193 Richmond VA 23218-1193 Employer code 5 digits A Phone 1-800-441-2258 Employer name Employee s annual salary 1 - EMPLOYEE INFORMATION Social Security number Street address Sex Male Female VRS-39 abcd Clear Form City Married Age Single State Date of birth mo/day/yr Employment date mo/day/yr Zip c.

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