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Ss: oci.wi.gov Sections 601.41 (8), 635.10, Wis. Stat. This form is designed for an employer s initial application for coverage. Please contact your agent or the insurer to determine if this form should be used in other situations once the group is enrolled with the insurer. SMALL EMPLOYER UNIFORM EMPLOYEE APPLICATION FOR GROUP HEALTH INSURANCE EMPLOYER INFORMATION To be filled out by Employer Employer Name Group Number Division Numb.

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