Revision: 03/31/2017. SAME name AFFIDAVIT . Insurance Company: _____. I, _____, do state that _____. and _____ are one and the same person. I am listed as beneficiary on policy number _____, issued to _____. Beneficiary: _____ Date: _____. Witness: _____ Date: _____. Box 1666 Gadsden, Alabama 35902 Phone: (256) 547-6998 Fax: (256) 547-0623. Email: Website.
SAME NAME AFFIDAVIT I, _____, do state that _____ and _____ are one and the same person. I am listed as beneficiary on policy number _____,
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1 Revision: 03/31/2017. SAME name AFFIDAVIT . Insurance Company: _____. I, _____, do state that _____. and _____ are one and the same person. I am listed as beneficiary on policy number _____, issued to _____. Beneficiary: _____ Date: _____. Witness: _____ Date: _____. Box 1666 Gadsden, Alabama 35902 Phone: (256) 547-6998 Fax: (256) 547-0623. Email: Website.
LOST POLICY AFFIDAVIT Return to: PO BOX 833879 RICHARDSON TX 75083-3879 P R O T E C T I N G P E P L E • W O R LD W I D E • R Champions Life Insurance …
bmv 4806 4/15 [760-1512] page 1 of 2 restricted ohio department of public safety bureau of motor vehicles application and affidavit for historical license plates
certificate and affidavit of satisfaction . commonwealth of virginia . va. code §§ 55-66.3 to 55-66.6
12. List any entity subject to regulation by an insurance regulatory authority that you control directly or indirectly. The term “control” (including the terms “controlling,” “controlled by” and “under common control with”) means the
The vehicle identified above is not being operated for reasons that may include but are not limited to military deployment, mechanical issues, and storage or seasonal usage.
NYC Department of Transportation Bureau of Permit Management and Construction Control 55 Water Street, New York, NY 10041 www.nyc.gov/dot AFFIDAVIT OF OWNERSHIP
AFFIDAVIT OF DOMESTIC PARTNERSHIP DECLARATION We certify that is a Domestic Partner of