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Get IRS 8963 2015

Nsurance Provider Information OMB Number 1545-2249 Information about Form 8963 and its separate instructions is at www.irs.gov/form8963. Check only one box below (see instructions) Single-person covered entity: Publicly Available Information Read the instructions before you complete Form 8963. Corrected report (see instructions) Designated entity: 1 Single-person covered entity 2a Agent of an affiliated group 2b Other Employer identification number (EIN) Number of controlled group.

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