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1. PLEASE FULLY COMPLETE THIS FORM 2. ATTACH ITEMIZED BILLS 3. MAIL TO HER E-Mail: disclaims hsri.com HER Plaza II 4100 Medical Parkway Carrollton, Texas 75007 Phone: (972) 512-5600 Fax: (972) 512-5820

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How to fill out part i policyholder s

How to fill out Part I Policyholder's:

01

Start by carefully reading the instructions provided on the form.

02

Gather all the necessary information related to the policyholder, such as their full name, address, contact details, and any additional required information.

03

In the designated fields, accurately input the policyholder's personal information, ensuring that there are no errors or misspellings.

04

If applicable, provide details regarding any other individuals covered under the policy, such as dependents or beneficiaries. Include their names, relationships, and relevant information as requested.

05

Remember to review all the entered information before proceeding to the next section to ensure accuracy and completeness.

06

Once you have filled out all the required information in Part I, double-check to ensure that all fields have been properly addressed and that there are no blank spaces or missing data.

07

Finally, sign and date the form as the policyholder or the authorized representative, depending on the specific instructions provided.

Who needs Part I Policyholder's:

01

Individuals who are applying for or renewing an insurance policy.

02

Insurance agents or brokers who are assisting clients in completing the necessary paperwork.

03

Policyholders who are making changes or updates to their current insurance coverage.

It is crucial to fill out Part I accurately and completely to avoid any delays or discrepancies in the insurance process.

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What is part i policyholder s?

Part I policyholder refers to the individual or entity that holds the insurance policy.

Who is required to file part i policyholder s?

The policyholder is required to file Part I policyholder section of the insurance documentation.

How to fill out part i policyholder s?

You can fill out the Part I policyholder section by providing the necessary information about the policyholder.

What is the purpose of part i policyholder s?

The purpose of the Part I policyholder section is to identify and provide details about the entity or individual holding the insurance policy.

What information must be reported on part i policyholder s?

The information reported on the Part I policyholder section typically includes name, contact information, and policy details of the policyholder.

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