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Application to Split Premium Please print in blue or black ink. Group Number 0 8 5 0 0 0NOTE: Changes can not be made in the enrollment system until the district receives an approval from TRS/Aetna.
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The 8709577-304-mb-split premium is a specific premium form used for reporting certain insurance premiums that are split among multiple parties or entities.
Typically, entities or individuals who are responsible for collecting and remitting insurance premiums related to the specified coverage are required to file the 8709577-304-mb-split premium.
To fill out the 8709577-304-mb-split premium, gather all relevant information about the premium amounts, the parties involved, and any applicable tax identification details, then follow the provided instructions on the form.
The purpose of the 8709577-304-mb-split premium is to facilitate the accurate reporting and remittance of premium taxes, ensuring compliance with regulatory requirements.
The form requires information such as the total premium amounts, the breakdown of premiums by entity, tax identification numbers, and any relevant dates or identifiers.
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