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[null,"**NOTE: All group and employee information must be completed before submitting your census**"]
[{"$nulls":8},"Definitions"]
[null,"Name of Brewery:",null,"Tax ID #:",null,"4-digit SIC Code:",null,null,"EE: Employee Only"]
[null,"Address:",null,"City:",null,"State:",null,null,"ES: Employee + Spouse"]
[null,"Total # of EEs:",null,"# of EEs on Current  Plan:",null,"Zip Code:",null,null,"EC: Employee + Child(ren)"]
[null,"Current Carrier:",null,"# of years with Carrier:",null,"Desired Effective Date:",null,null,"EF: Family"]
[{"$nulls":8},"W: Waiving Coverage"]
[null,null,null,"Please direct any questions to Amina McGee at 678-538-2894 or amcgee@pjins.com"]
[null,"Relationship\n(Employee, Spouse, Child)","First Name","Last Name","Address","City","State","ZIP","Gender","DOB","Age","Coverage Tier \n(EE, ES, EC, EF)","Full-time > 30hrs/week\nPart-Time < 30hrs/week"]
[null,"EMP"," John"," Smith"," 123 Example St.","St. Petersburg","FL",33712,"Male","1990-11-12",30,"EF","Full-Time"]
[null,"SPS"," Mary "," Smith",{"$nulls":4},"Female","1990-11-13",30]
[null,"DEP"," John Jr."," Smith",{"$nulls":4},"Male","2019-11-14",1]
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