• General ACA Questionaire- WE ARE NOT DOING ANY MORE ENROLLMENTS UNTIL NOVEMBER 1, 2017

    Please fill out this questionaire to determine if you are eligible for a health insurance subsidy.

  • New Clients Only

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  • If more than, pls put in additional information.

  • Please include a copy of your id.

  • By signing this this form, you agree to allow Chi Ching Financial to use this information to assist you in enrolling in a health insurance and/or dental insurance plan.