Get Oregon Rescission Report Form

The Oregon Rescission Report Form is essential for reporting rescissions of long-term care insurance policies. This guide will walk you through each component of the form, providing clear instructions to ensure accurate submission.

Follow the steps to complete the Oregon Rescission Report Form online.

1. Use the ‘Get Form’ button to access the Oregon Rescission Report Form and open it in the available editor.
2. Begin filling out the form by providing your company name in the designated field. Ensure that the name matches the registered entity offering the long-term care policies.
3. Next, enter the complete address of your company, including street, city, state, and zip code. This information is crucial for accurate identification and communication.
4. In the phone number field, provide a contact number where you can be reached for any clarifications regarding the report.
5. On the line labeled 'For the reporting year,' fill in the appropriate year for which you are reporting rescissions. This is typically the current reporting year.
6. Fill out the details for each rescission. Start with the date of policy issuance, providing the specific day, month, and year as required.
7. Next, list the policy and certificate numbers associated with the rescinded long-term care policies. Each rescission requires a separate line.
8. Identify the name of the insured person who held the policy being rescinded. This is necessary for records and validation.
9. In the 'Date/s of claim/s submitted' section, enter the dates relevant to any claims made under the policy before its rescission.
10. Provide the detailed reason for the rescission in the specified section. Be thorough and clear to ensure that the reasoning is understandable.
11. Finally, sign the form by adding your signature. Below the signature, please type your name and title to confirm your authority to submit this report.
12. Once all fields are completed, you can save your changes, download a copy, print, or share the Oregon Rescission Report Form as needed.

Complete your documents online with ease and accuracy by utilizing this guide.