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Get Motion Picture Industry Health Plans Beneficiary/Enrollment Form 2016-2024

E MPI Pension, IAP and Health Plans This form is used to enroll you and your dependents in the Health Plan and to designate the beneficiary(ies) of your life insurance. Benefits will not commence and claims will not be paid until your Beneficiary/Enrollment form is received in the Plan office. Please note that it must be completed and signed by the Participant before it will be accepted as a valid record. Social Security Number Last Name First Name Middle Date of Birth ï‚… Female ï‚… Male .

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