Get Nmmip Supplemental Application Form 2017
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How to fill out the NMMIP Supplemental Application Form online
Completing the NMMIP Supplemental Application Form online is an essential step for individuals seeking reduced premium coverage through the Low Income Premium Program. This guide provides straightforward instructions to ensure a smooth application process.
Follow the steps to successfully complete your NMMIP Supplemental Application Form.
- Press the ‘Get Form’ button to access the application form and open it for editing.
- Fill out the applicant information section, including last name, first name, middle initial, ID number, and address. Ensure all fields are accurately completed.
- In the premium payment certification section, confirm that you, or a member of your family, will be responsible for paying the premiums by providing your name.
- Provide details regarding your household size. List all individuals residing in your household, their names, relationships, and dates of birth. Use additional sheets if necessary.
- Indicate the total annual income for all adults in your household, excluding any income from SSI or TANF. This information should come from your Federal Tax Form.
- Attach a copy of the previous year's Federal Income Tax forms for all members who earned income, and complete Affidavit A if applicable.
- If any adults did not file a Federal Income Tax form, ensure they complete and notarize Affidavit B regarding their income information.
- Review all entered information for accuracy. Once confirmed, save your changes, and choose to download, print, or share your completed form.
Take the next step towards reduced premium coverage by completing your NMMIP Supplemental Application Form online today.
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