You must apply for and receive an exemption letter from the Employment Security Department (ESD). before submitting this form.
Use this form to submit your letter of exemption for long-term care insurance to the City of Bellingham Human Resources Department.
If you would like to complete this form on a mobile phone to make uploading an image of your exemption letter easier, type in “cob.org/LTCinsurance” in your phone’s browser or take a picture of the QR code below using your phone camera:
