- 990
I can't seem to get the pdf on this C*%*)%_ site, but here it is typed out "verbatim."
PART V: AUTHORIZATIONS / ACKNOWLEDGEMENTS
CANCELLATION PROVISION
I understand that Blue Cross and Blue Sheild of Florida, Inc. may cancel this coverage for all insureds covered by it after giving 90 days notice, and that any unearned premiums will be returned to me. I also understand that such action will not be taken solely because of the amount of claims paid under this policy.
Applicant's signature X___________ Date:_____________
(If child, parent/guardian's signature required)
I can pdf file a copy of the actual application page if an email address is provided.
PART V: AUTHORIZATIONS / ACKNOWLEDGEMENTS
CANCELLATION PROVISION
I understand that Blue Cross and Blue Sheild of Florida, Inc. may cancel this coverage for all insureds covered by it after giving 90 days notice, and that any unearned premiums will be returned to me. I also understand that such action will not be taken solely because of the amount of claims paid under this policy.
Applicant's signature X___________ Date:_____________
(If child, parent/guardian's signature required)
I can pdf file a copy of the actual application page if an email address is provided.