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06/28/2017ACTIVE PRIVATE SELF INSURED ROSTER220701290 BROADS PIRE SERVICES, INC., AREA Ms. Felicia Thornton SVP & CFO 99 CENTS ONLY STORES LLC 4000 Union Pacific Ave Commerce, CA 90023Phone: (323)

How to fill out active private self insured

How to Fill Out Active Private Self Insured:

1. Gather necessary information: Start by collecting all relevant personal and insurance details such as your name, contact information, policy number, and any other required details.
2. Understand the coverage: Carefully review the terms and conditions of your active private self-insurance policy to comprehend the scope and limitations of your coverage. Take note of any specific requirements or conditions for filing a claim.
3. Complete the claim form: Fill out the claim form accurately and provide all the requested information. This may include details about the incident or event that led to the claim, along with any supporting documentation like receipts, bills, or relevant photographs.
4. Consult professional assistance if needed: If you have any uncertainties or difficulties in completing the claim form, don't hesitate to reach out to your insurance provider's customer service or seek guidance from a licensed agent. They can provide you with the necessary support and answer any queries you may have.
5. Review before submission: Before submitting the filled-out claim form, review all the provided information to ensure accuracy and completeness. Double-check that you have attached all necessary supporting documents and that you have complied with any additional requirements outlined in your policy.
6. Submit the claim: Once you are confident everything is in order, submit the completed claim form along with any required documents to your insurance provider. Follow the submission instructions provided by your insurer, whether it involves sending the claim form by mail, fax, email, or through an online portal.

Who Needs Active Private Self Insured:

1. Self-employed individuals: Active private self-insured coverage can be beneficial for self-employed individuals who do not have the option of receiving insurance coverage through an employer. It allows them to have a safety net for unexpected events or accidents that may affect their business or personal life.
2. Small business owners: Small business owners who want to have more control over their insurance coverage and costs may choose to opt for active private self-insured policies. This allows them to customize their coverage to meet their specific needs while potentially saving on premiums.
3. Individuals with unique or high-risk circumstances: Active private self-insured coverage can be attractive to individuals who have unique or high-risk circumstances that may not be adequately covered by traditional insurance providers. It gives them the flexibility to tailor their coverage to suit their specific needs.

Remember, it is always advisable to consult with insurance professionals or licensed agents who can provide guidance based on your individual circumstances and requirements.

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