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Reset FormADDITIONAL PREMIUM ACKNOWLEDGEMENTSammons Retirement Solutions Inc. P.O. Box 758547, Topeka, KS 666758547Overnight: Mail Zone 547, 5801 SW 6th Ave. Topeka, KS 666361001Issued by Midland
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How to fill out additional premium acknowledgement

01
To fill out additional premium acknowledgement, follow these steps:
02
Start by opening the acknowledgement form provided by the insurance company.
03
Read through the form carefully to understand the information required.
04
Fill in your personal details such as name, address, policy number, and contact information.
05
Identify the additional premium amount that needs to be acknowledged.
06
Write down the payment method you used to pay the additional premium.
07
Specify the date on which the payment was made.
08
Sign and date the acknowledgement form.
09
Review the completed form to ensure all information is accurate.
10
Submit the form to the insurance company through the preferred mode of communication, such as mail or email.
11
Keep a copy of the completed form for your records.

Who needs additional premium acknowledgement?

01
Additional premium acknowledgement is typically required by individuals who have made an extra payment towards their insurance policy.
02
It is necessary for policyholders who want to ensure that their additional premium is properly recorded and acknowledged by the insurance company.
03
In some cases, individuals who have made modifications to their policy that require an additional premium may also need to fill out this acknowledgement.
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Additional premium acknowledgement is a form used to report and acknowledge any extra premiums that need to be paid by the policyholder.
The policyholder or insured individual is required to file the additional premium acknowledgement if they have been notified of any extra premiums.
To fill out the additional premium acknowledgement, the policyholder must provide their personal information, policy details, and information about the additional premiums being paid.
The purpose of additional premium acknowledgement is to acknowledge and report any additional premiums that need to be paid on top of the regular premium amount.
The additional premium acknowledgement form must include details about the policyholder, policy number, amount of additional premiums, and reason for the extra premiums.
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