CÃÂºram V7 User Interface

New Beneficiary Evidence

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* required field

Received Date

Beneficiary Details

If the beneficiary is a case participant, please select from below.

Beneficiary Participant

If the beneficiary is not a case participant but is registered on the system, please select from below.

Beneficiary

If the beneficiary is not registered on the system, complete the beneficiary details below.

Beneficiary Name

Phone Area Code

Phone Number

Other Details

Start Date

End Date

Relationship of Grantor to Beneficiary

Accessible Value

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