4M Trucking Insurance Questionaire

This form is for all 4M Trucking and Service Center employees.
4M Trucking is evaluating different health insurance options for employees and their dependents. The health insurance companies have requested information on any individual that will be covered under the proposed plans. This includes the employee, spouse, children, and other valid dependent.
Please complete this form even if you choose to opt out of employeer provided insurance.

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