Responsibility for Distribution and Notification Requirements. Please see this section for important timelines for distribution of information. It is agreed that this application supersedes any previous application for this Contract. Dated at (City, State) this day of 20 (Legal Name of Contractholder) By Title PLEASE SIGN, DATE AND RETURN THE ORIGINAL APPLICATION PAGE TO BLUE SHIELD OF CALIFORNIA AT THE ABOVE ADDRESS. RETAIN THE CONTRACT. Inquiries concerning any problems that may develop in the administration of this Contract should be directed to Blue Shield of California at the address provided on page GC-1.
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Samples: www.sb-court.org, www.scu.edu, mrstaxbenefits.com