CS-1781 Beneficiary Designation Change - michigan.gov
CS-1781 REV 5/2010 State of Michigan Civil Service Commission EMPLOYEE BENEFITS DIVISION LIFE INSURANCE AND ACCIDENTAL DUTY DEATH BENEFICIARY DESIGNATION OR CHANGE FORM EMPLOYEE DATA INSU FOR HUMAN RESOURCES USE ONLY Employee I.D. Number Social Security Number Deduction Code Effective Date Unit Code Department/Agency
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