Example: bankruptcy

Authorization To Deduct Insurance Premiums

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OWNER / OPERATOR ENROLLMENT PACKET

OWNER / OPERATOR ENROLLMENT PACKET

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Operator accepts a recommended Occupational Accident Insurance plan or provider, then Owner / Operator authorizes and directs SCI to deduct directly from any compensation payable to Owner / Operator a program fee for services furnished hereunder, the costs and premiums payable in connection with the maintenance of such policy for Owner /

  Insurance, Premium, Ducted, To deduct

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