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RECEIPT AND STATEMENT OF CHARGES American Contractors Indemnity Company A member of HCC Surety Group 9841 Airport Blvd., 9th Floor, Los Angeles, CA 90045 Received from: POWER NUMBER NAME ADDRESS DATE

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What is premium and collateral receipts?

Premium and collateral receipts are documents that show the payment of premium for insurance coverage and the collateral provided as security for a loan or transaction.

Who is required to file premium and collateral receipts?

Insurance companies, lenders, and financial institutions are required to file premium and collateral receipts as part of their regulatory requirements.

How to fill out premium and collateral receipts?

Premium and collateral receipts should be filled out with details of the premium amount paid, description of the collateral provided, and relevant dates and signatures.

What is the purpose of premium and collateral receipts?

The purpose of premium and collateral receipts is to provide proof of payment and security in insurance and financial transactions.

What information must be reported on premium and collateral receipts?

Premium and collateral receipts must include details such as the payer's name, payment amount, type of coverage or loan, collateral description, and dates.

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