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Member
Member ID 123456789
Alternate ID 987654321
Member Name PERRIER, NANCY M
Date of Birth 01/01/1956
Address 3429 ABC LN
SEBAST, AL 30000
Alternate Address
Marital Status -
Home Phone
Work Phone
Relationship 2
Gender F - Female
 
Eligibility
Effective Date 01/01/1996
Expiration Date
COB Effective Date ValueOptions contract coverage. Indicates the rules of primacy for claim liability.
Subscriber
Subscriber ID 9876543210
Subscriber Name DONALD J. PERRIER
 

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