Get B. Cancellation Form - Zachary Community Schools - Zacharyschools

This guide provides clear instructions on completing the B. Cancellation Form for Zachary Community Schools, ensuring a smooth and efficient process. Follow the steps carefully to ensure all necessary information is provided correctly.

Follow the steps to complete the cancellation form accurately.

1. To obtain the form, press the ‘Get Form’ button and open it in your preferred editor.
2. Fill in the 'Group Name' field with 'Zachary Community School Board' and 'Group Number' as '77216FF1-0001'.
3. Indicate which coverage products are to be cancelled by checking the appropriate boxes for health, dental, group term life, or any other product.
4. Enter the 'Requested Termination Date' and the 'Last Date of Employment' below.
5. Provide the reason for termination, and list any dependents affected by this cancellation, including their names and relationships.
6. Acknowledge the statements regarding payment and expectations of coverage by providing the required signatures for both the employee and an authorized representative of the group.
7. Finally, review the completed form for accuracy, then choose to save changes, print, or share the form as needed.

Complete your B. Cancellation Form online today for an efficient and streamlined process.