Get the free PART I - POLICYHOLDERS REPORT - bcbcbaseballbborgb

HER Plaza 4001 N. Jose Lane Carrollton, Texas 75007 Phone: (972× 4926474 Fax: (972× 4924946 1. PLEASE FULLY COMPLETE THIS FORM 2. ATTACH ITEMIZED BILLS 3. MAIL TO Email: claims hsri.com POLICY NUMBER:

How to fill out part i - policyholders

How to fill out part i - policyholders?

1. Fill in the required information: Start by providing the full name of the policyholder, including any middle name or initial. Make sure to write it exactly as it appears on official documents.
2. Policyholder's contact details: Enter the current residential address of the policyholder, including the street name, city, state, and zip code. If the policyholder has a mailing address different from the residential one, provide it separately.
3. Date of birth and gender: Indicate the policyholder's date of birth using the format specified in the form. Also, select the appropriate gender category, either male or female.
4. Social security number or taxpayer identification number: Provide the policyholder's social security number (SSN) or taxpayer identification number (TIN) if required. This ensures accurate identification of the policyholder.
5. Citizenship information: Specify the policyholder's citizenship status by selecting the appropriate option, such as U.S. citizen, non-U.S. citizen, or resident alien. Include any necessary supporting documents if requested.
6. Employer's details: If the policyholder is employed, include the name and address of their current employer. If unemployed, record the previous employer or write N/A if applicable.
7. Other insurance coverage: Indicate whether the policyholder has any other existing insurance coverage or not. If yes, provide the details of the other insurance policies, including the type of coverage and the insurance company's name.
8. Signature and date: Sign and date the form in the designated spaces to authenticate the information provided.

Who needs part i - policyholders?

1. Individuals applying for insurance: When filling out an insurance application, the policyholder is required to complete part i - policyholders. This section gathers essential information needed to process the insurance policy accurately.
2. Policyholders seeking to update their information: If existing policyholders need to update their personal details, such as address or employer's information, they may be required to fill out part i - policyholders.
3. Insurance agents or brokers: Insurance agents or brokers assisting clients with their insurance application or policy updates need to understand the requirements of part i - policyholders to guide their customers accordingly.

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