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    <title>Annual Survey - Ohio Health Insurance Business</title>
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                 <div  class="FrmTitleBackGrnd"  style="font-weight: bold; color: #000000;">
                         Annual Report of Ohio Health Insurance Business (LHSurvey) - Company Statement
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                             href="Instructions/Help.pdf" target="helpwindow">Help</a>
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                         <tr valign="baseline">
                             <td width="14">
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                             <td height="20" class="FrmInfo">Data for <b>
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                             </b>
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                         <tr valign="baseline">
                             <td width="14">
                                 <img src="/images/frmBullet.gif" alt="" /></td>
                             <td height="20" class="FrmInfo">NAIC Number:<b>
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                             <td width="14">
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                                 <b>INFORMATION RELATED ONLY TO BUSINESS IN OHIO</b></td>
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                             <td height="20" class="FrmInfo">
                                 <b>REPORTING FOR THE PREVIOUS YEAR BEGINS MID-MARCH</b></td>
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                                 <b>CURRENTLY VIEWING FOR THE YEAR ENDING
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                                 <b>INSTRUCTIONS:</b>
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                             <td width="14">
                                 <img src="/images/frmBullet.gif" alt="" /></td>
                             <td height="20" class="FrmInfo">Complete all required fields (marked with an <span class="Required">*</span>).
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                                 <b>SAVE DATA BEFORE LEAVING THIS PAGE</b>.
                             </td>
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                                 <asp:ValidationSummary ID="vsError" runat="server" EnableViewState="False" Width="100%" CssClass="frmError"
                                     HeaderText="<u><b>PLEASE CORRECT THE FOLLOWING ERROR(S) :</b></u>" ShowMessageBox="True"></asp:ValidationSummary>
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                         <tr>
                             <td class="medfont" colspan="5">
                                 <b>COMPANY STATEMENT:<br>
                                     THE COMPANY OFFICIAL LISTED BELOW DECLARES THAT THE INFORMATION SUPPLIED IN 
																		    THIS REPORT OF OHIO HEALTH INSURANCE BUSINESS HAS BEEN REVIEWED AND IS COMPLETE 
																		    AND TRUE. </b>
                             </td>
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                         <tr>
                             <td class="FrmFieldTxt" colspan="5">&nbsp;</td>
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                         <tr>
                             <td bgcolor="#cccccc" height="20" class="FrmSecHead" colspan="5">COMPANY OFFICIAL:</td>
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                                 <asp:Label ID="lblOffFName" runat="server" ToolTip="Please enter Officer First Name.">First Name&nbsp;</asp:Label>
                                 <span class="Required">*</span>
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                         <tr>
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                                 <asp:Label ID="lblOffLName" runat="server" ToolTip="Please enter Officer Name.">Last Name&nbsp;</asp:Label>
                                 <span class="Required">*</span>
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                                 <asp:Label ID="lblOffPh" runat="server" ToolTip="Please enter Officer Phone." Text="Phone&nbsp;">Phone&nbsp;</asp:Label>
                                 <span class="Required">*</span>
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                                 <asp:Label ID="lblOffEmail" runat="server" ToolTip="Please enter Officer Email." Text="Email&nbsp;">Email&nbsp;</asp:Label>
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