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Employer. NAME OF ASSOCIATION, UNION OR TRUSTEES hereby gives notice that EMPLOYER'S participation in the Disability Benefit Plan identified above is to be terminated, as indicated herein: A. EMPLOYER'S NAME AND ADDRESS B. EMPLOYER'S U.I. REGISTRATION NO. C. APPROXIMATE NUMBER OF EMPLOYEES COVERED E. PAYROLL RECORDS ADDRESS, IF DIFFERENT D. NAME UNDER WHICH EMPLOYER CONDUCTS BUSINESS MONTH, DAY, YEAR MONTH, DAY, YEAR 1. Date that EMPLOYER'S participation in the Plan identified above...

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