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59511ORGANIZATION AUTHORIZATION FOR ELECTRONIC PAYMENT NORTH DAKOTA PUBLIC EMPLOYEES RETIREMENT SYSTEM SON 59511 (Rev. 042017)PAPERS 400 East Broadway PO Box 1657 Bismarck North Dakota 585021657 (701)

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How to fill out authorization for automatic premium

01

Obtain the authorization form from your insurance company.

02

Read the instructions carefully to understand the requirements.

03

Fill in your personal details accurately, including your name, address, and contact information.

04

Provide your insurance policy number and any other required policy information.

05

Select the automatic premium payment option and indicate the frequency of payments.

06

Sign and date the authorization form.

07

Submit the completed form to your insurance company either through mail or electronically.

Who needs authorization for automatic premium?

01

Anyone who wishes to automate their premium payments and has an existing insurance policy can benefit from authorization for automatic premium.

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What is authorization for automatic premium?

Authorization for automatic premium is a form that allows an insurance company to automatically deduct premiums from a policyholder's bank account.

Who is required to file authorization for automatic premium?

Policyholders who wish to have their insurance premiums automatically deducted from their bank account are required to file authorization for automatic premium.

How to fill out authorization for automatic premium?

Authorization for automatic premium can be filled out by providing personal and bank account information on the form provided by the insurance company.

What is the purpose of authorization for automatic premium?

The purpose of authorization for automatic premium is to streamline the premium payment process for policyholders and insurance companies.

What information must be reported on authorization for automatic premium?

Information such as policyholder's name, policy number, bank account details, and authorization for automatic premium amount must be reported on the form.

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