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Ce member. 3. A representative of the Uniformed Services must sign his or her name below that of the service member to indicate that he or she received the form from the member (whether in person, by mail or electronically) and should include the date he or she received it. 4. This form, properly completed, is authority to a payroll office to change or stop the deductions for Family Coverage premiums if the amount of insurance is changed or canceled. 5. After the form is completed in its entiret.

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