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Company Logo: Broker of Record Letter To: All Hmo Providers
Company Logo: Broker of Record Letter To: All Hmo Providers
DATE
May request you to furnish the abovementioned all pertinent information required, in
connection with this service.
This supersedes all previous communications and instructions. The authority herein shall
remain in full force until cancelled in writing within 365 days notice.
Thank you!
Respectfully Yours,
AUTHORIZED SIGNATORY
(Signature over printed name/ Position)
Date Signed