Item #: 1679703 | Model #: DLF513-SL
Adams® Employee Certification of Cancellation of Dependent Health Coverage, 1-Use Interactive Digital Legal Form CANCELLED
Rollover image to zoom in
https://www.staples-3p.com/s7/is/image/Staples/m003904310_sc7?wid=512&hei=512
https://www.staples-3p.com/s7/is/image/Staples/s1056172_sc7?wid=512&hei=512
https://www.staples-3p.com/s7/is/image/Staples/s1056173_sc7?wid=512&hei=512
https://www.staples-3p.com/s7/is/image/Staples/s1056174_sc7?wid=512&hei=512
https://www.staples-3p.com/s7/is/image/Staples/m002395161_sc7?wid=512&hei=512

Adams® Employee Certification of Cancellation of Dependent Health Coverage, 1-Use Interactive Digital Legal Form CANCELLED

No reviews yet
Share:
false
Each
Delivered by Tue, Aug 21
$6.99
This item not available in stores
Qty:

Staples memberships could save you more | Learn More

Product Details
  • Easy-to-follow questionnaire
  • After completing your online questionnaire, document is instantly available
  • Download completed forms after online assembly
Go to full description & specifications


6.99
6.99
https://www.staples-3p.com/s7/is/image/Staples/m003904310
00000000000000
Adams
Adams® Employee Certification of Cancellation of Dependent Health Coverage, 1-Use Interactive Digital Legal Form CANCELLED
Product Description
The Adams online interactive forms let you instantly create high-quality legal documents tailored to your needs. These forms are powered by DirectLaw smart forms technology.

Employers or plan administrators may use this letter as a notice of late payment to an employee or beneficiary receiving group health plan coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).

  • Easy-to-follow questionnaire
  • After completing your online questionnaire, document is instantly available
  • Download completed forms after online assembly
  • Web browser: Microsoft Internet Explorer 7.0 or higher , Mozilla Firefox , Google Chrome , Safari 6.0 and earlier , Android standard browser
  • Print as many copies as you need
  • Step-by-step instructions included with your assembled form help you to file or execute your documents correctly
  • Legal forms created by attorneys
  • Valid for every state
Specifications
Legal Form Class Small Business
Legal Form Type HR/Personnel
Digital or Preprinted Form Digital Form
Reviews