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PART C AFFIDAVIT BY PRODUCING BROKER 1. PRODUCING BROKER INFORMATION AFFIDAVIT NO. License No. BR Name Address City State Zip Code 2. RISK INFORMATION: Name of the Insured (The name of the insured

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The Part C Form 052311 is a form used for reporting certain financial information.

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Entities that meet specific criteria set by the governing body are required to file Part C Form 052311.

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Part C Form 052311 can be filled out electronically or manually following the instructions provided by the governing body.

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The purpose of Part C Form 052311 is to gather financial information from entities for regulatory or compliance reasons.

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Part C Form 052311 requires entities to report detailed financial information such as income, expenses, and assets.

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