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Old Group List
Group Name:
Agent Name:
Effective Date:
SIC or Industry:
Group City:
Group zip code:
Date Entered:
Census Notes:
Group Name:
Agent Name:
Notes
Number of EEs
Notes
SIC
City
Zip
Zip
Notes
Status:
Status:
Status Notes:
GA Submitted to:
Census 
Supporting document 2 notes
Supporting document 3 notes
Supporting document 4 notes
Supporting document 5 notes
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New proposals
Renewal documents
Group documents / Important
Employees

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Group Name:
Group Name:
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Group Name:
Group Name:
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Group Master / Important Documents

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Group Name:
Group Name:
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Add Employees

Add New Employee
Group Name:
Group Name:
Dependent census info:
List dependent information for this employee here. Name, date of birth, spouse or child.

Notes on this employee:
Notes on this employee

Create Date:
Date Updated:

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To edit, click on the employee name below.
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Group Proposals

Group Renewal

Group Master / Important Documents

View Census

Employees

Census Notes:
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