Please email the following documents to Team@safepolicies.com (copy of passport, social security card, pay stub & driver license are needed for identity verificate) Green Card/I-551 • I-766 •I-94/ I-94A) • ORR (ORR UAC/R-1) • Passport • Visa with I-94 stamp • I-797 USCIS • I-589 USCIS Confirmation(A5)
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Broker Assignment Letter(經紀人委派信)I, ____________appoint Nelson Lai as my broker for NY State Of Health medical & dental insurance.我 _______________委託Nelson Lai 擔當我紐約州健康醫療和牙科保險的經紀人。
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Date (MM/DD/YYYY)
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Signature(Type your name)
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Family Member (Name/Date Of Birth/SSN/Gender/Relationship)