Professional legal forms

Schedule of florida sales or u... Paid on Orig. Pur. ... Use Form DR-95B to calculate credits for sales and use tax paid on ... Column 4 - Sales tax paid on original purchase - include discretionary ...

This evidence of insurance doc... INTERNATIONAL PAPER INSURANCE DOCUMENTATIONFor Year 2020This evidence of insurance documentation is provided for our business partners, including customers and property/equipment lessors, who require

Insurance documentation form INTERNATIONAL PAPER INSURANCE DOCUMENTATIONFor Year 2018This evidence of insurance documentation is provided for our business partners, including customers and property/equipment lessors, who require

International paper insurance... INTERNATIONAL PAPER INSURANCE DOCUMENTATIONFor Year 2017This evidence of insurance documentation is provided for our business partners, including customers and property/equipment lessors, who require

This evidence of insurance doc... INTERNATIONAL PAPER INSURANCE DOCUMENTATIONFor Year 2019This evidence of insurance documentation is provided for our business partners, including customers and property/equipment lessors, who require

Travel insurance documents for... TRAVEL INSURANCE CLAIM FORM AAR INSURANCE KENYA LIMITED GEORGE WILLIAMSON HOUSE, 4TH GONG, 2ND FLOOR, P.O. BOX 4176600100, TEL: 020 2895000/2715319 FAX: 020 2715328, EMAIL: info AAR.co.KE MESA PLAYBILL

Your insurance documentation b... Your Insurance Documentation British Airways American Express Credit Card YOUR INSURANCE DOCUMENTATION BRITISH AIRWAYS AMERICAN EXPRESS CREDIT CARD Contains: Key Information: (i) Policy Summary (ii)

Life insurance application lz... LIA-WP (10/08) LIFE INSURANCE APPLICATION 100 Quentin Roosevelt Boulevard, Garden City, NY 11530 Internet address: www.wpenn.com INSTRUCTIONS As the Agent, you are responsible for completing the necessary

Utah health insurance applicat... Page 1 of 5 Utah Small Employer Health Insurance Application July 2009 D. WAIVER OF COVERAGE Complete this section for yourself if waiving and/or any of your dependents for whom you are waiving coverage. UTAH SMALL EMPLOYER HEALTH INSURANCE APPLICATION OFFICE USE ONLY Policy / Group No. REASON FOR ENROLLMENT mark all that apply New Group Newborn Loss of Coverage Open Enrollment Marriage Court Order New Hire Divorce Other New Application Re-apply Dependent Addition Date of Event COBRA / Utah mini-COBRA / Alternative Coverage for Employee Dependent Employer Name Effective Date PEC New Hire Waiting Period Length of COBRA continuation coverage 18 mos. 36 mos. Other Original Qualifying Event Date Qualifying Event Date Coverage Medical Dental Vision Self COVERAGE REQUESTED Spouse Child ren COBRA Utah mini-COBRA Alternative Coverage A. EMPLOYER INFORMATION Employer Hire Date Location Is this a division Yes Rehire Date No If Yes name of parent company Name Last Marital Status First Legally Married Single MI Widowed Home or other Phone Hrs/Week Domestic Partner Apt. Address Job Title City State Business Phone Spouse s Business or other Phone Spouse s Employer Zip Driver s License Number Email Address C. ENROLLING EMPLOYEE / SPOUSE / DEPENDENTS attach separate sheet if necessary In the section below list yourself and all eligible family members to be included under coverage. Social Security for internal use only Name Last First MI Date of Birth No lbs. Dependent Rx M/F Age Weight HICN Eligible family members include spouse natural child stepchild adopted child child placed for adoption and child for whom you are appointed as legal guardian by the court. To be eligible for coverage children must be under the age of 26 unmarried and dependent upon you for 50 percent of their financial support. Financial dependency is not required for courtordered child coverage. Any dependent not listed will not be considered for coverage. You may not enroll dependents if you are waiving except children subject to a Qualified Medical Child Support Order. If you decline enrollment in this plan for yourself and/or any of your dependents including your spouse because of other health care coverage you may in the future be able to enroll the omitted individual s in this plan provided that you request enrollment within 30 days after the other coverage of the individual s ends. Decline enrollment includes omission of the individual from this application* In addition if you have a new dependent as a result of marriage birth adoption or placement for adoption you may be able to enroll yourself and your dependents provided that you request enrollment within 30 days after the marriage birth adoption or placement for adoption the Special Enrollment Period. Please complete type of health care coverage for the employee and all eligible members who have other health care coverage by completing type of health care coverage i*e* group individual or other Medicare Medicaid V. A. H. I. P. etc*. All eligible family members must be listed in this section or the ENROLLING EMPLOYEE / SPOUSE / DEPENDENTS section* Persons waiving coverage.

Globe life insurance applicati... Globe Life And Accident Insurance Company Administrative Office: Globe Life Center, Oklahoma City, Oklahoma 73184 Group Enrollment Form for Accidental Death Policy Benefit Amount Payment Type $3,000

Earthquake cea application for... CALIFORNIA EARTHQUAKE AUTHORITY EARTHQUAKE INSURANCE APPLICATION INSTRUCTIONS POLICY EFFECTIVE DATE AND EXPIRATION DATE Provide CEA policy effective date and expiration date. CEA Earthquake Insurance Application Instructions 01/2012 Revision Earthquake Insurance Application Effective Date Applicant Information Applicant First Name Co-Applicant if applicable Last Name Middle Initial Number and Street Address City State Work Home Unit ZIP Code County Companion Policy Information Participating Insurer Type of Policy Homeowner Dwelling Coverage A Limit Renters Homeowners/Dwelling Fire Basic Program Rating Territory Year Built Construction Type Number of Stories in building Including Basement Is there unrepaired structural earthquake damage to the dwelling Frame Other Number of Chimneys Square Footage Foundation Type Roof Type Raised Slab Composition Tile Wood Shake Yes No If yes DO NOT BIND and explain in Remarks Dwelling secured to foundation Cripple walls braced with plywood or equivalent NOTE Inspections are required on all properties with existing non-structural i.e. cosmetic earthquake damage. Expiration date must be the same as the expiration date of the companion policy. APPLICANT Complete all requested information for applicant s including Name s Telephone number s Street address of physical location of insured property Mailing address if different from street address of property s physical location COMPANION POLICY INFORMATION Name of Participating Insurer Policy number of companion policy Dwelling limit i*e* Coverage A of companion policy if companion policy has dwelling limit Expiration date of companion policy Type of companion policy POLICY TYPE RATING AND COVERAGE INFORMATION Identify CEA policy type based on the type of companion policy as follows Homeowner Companion policy must be either a Homeowners HO-1 2 3 5 or 8 or equivalent Dwelling Fire building Landlord building or Mobilehome policy. o M anufactured Hom e M obilehom e Written on CEA Homeowner Policy form however requires unique rating information* Condominium i*e* Common Interest Development Companion policy must be a Condominium Unit Owners HO-6 or equivalent policy. Renters Companion policy must be a Renters HO-4 or equivalent Mobilehome tenant policy Dwelling Fire contents only or Landlord contents only policy. Complete all information requested under the applicable CEA policy type. Select desired CEA policy limits and coverage options. PAYMENT OPTIONS Select payment option Annual or Installments SEND BILL TO Select who should receive the bill Insured or Mortgagee ADDITIONAL INTERESTS Complete information requested for each additional interest including Type o Additional insured or o Loss payee Name and address Loan number if applicable REMARKS Include any additional remarks as needed* SIGNATURE Secure the applicant s signature on the application the date and time the application is completed* Provide the producer s name address and license number. Is the home reinforced by an earthquake resistant bracing system or installed upon an approved foundation system certified by the California Department of Housing and Community Development Water heater secured to building frame Option Two 75 000 AND Loss of Use Coverage D 25 000 50 000 100 000 No deductible for this coverage if Coverage A deductible is met.

Louisiana department of insura... L O U I S I A N A D E P A RT M E N T JAMES OF INSURANCE J. D O N E L O N COMMISSIONER INSTRUCTIONS FOR APPLICATION TO ACT AS A SPECIALTY INSURER IN THE STATE OF LOUISIANA GENERAL INSTRUCTIONS This

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