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Get SSA-2490-BK 2017-2021

NATIONAL SOCIAL SECURITY AGREEMENT If the worker is living, this application should be completed by or on behalf of the worker. If the worker is deceased, this application should be completed by one of the worker's survivors who is claiming benefits under the provisions of the international social security agreement. PART 1 Complete Part 1 in all cases. 1. (a) Print name of worker (First name, middle initial, last name) (b) U.S. Social Security Number 2. Provide the following information about.

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