w. If you have applied but are not covered yet. write "Pending" under Policy or ID P. Policy or ID a Name of person(s) covered by this insurance: Pnmary Insurance Company Major Medical Insurance Company Other Insurance (Union, Dental, Vision, etc.) Medicare Medicaid Workers' Compensation Auto Insurance Other ins

below If you have applied but are not covered yet. write 'Pending' under Policy or ID #. Poen or ID # Alamo ofarson's, myerefl by this incritiner Pnmary Insurance Company Major Medical Insurance Company Other Insurance (Union, Deed& Vision at) Medicare Medicaid Workers' Compensation Auto Insurance Other insurance