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Get Fis 0865 - State Of Michigan - Michigan
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How to fill out the FIS 0865 - State Of Michigan - Michigan online
This guide provides clear, step-by-step instructions on completing the FIS 0865 form for Third Party Administrators in Michigan. Follow these instructions to ensure your information is accurately submitted online.
Follow the steps to complete the FIS 0865 form online.
- Click ‘Get Form’ button to download the form and open it in your editor.
- Begin by entering the name of the Third Party Administrator (TPA) at the top of the form. Ensure that this name accurately matches your official records.
- Fill in the TPA Mailing Address Line 1. This can be a PO Box, and make sure to check the box indicating that the address has not changed since the last update or renewal if applicable.
- If any contact or organizational information has changed since your last update or renewal, complete the TPA Main Telephone number, TPA Main Fax number, and the website address if applicable.
- Indicate the type of business organization for the TPA, but only if there have been changes since the last update. Attach required documentation if there are changes to be reported.
- Attach a list of all officers, partners, stockholders of 10% or more, and all members of the Board of Directors, including any changes since your last report, in the specified format.
- Finally, submit the completed FIS 0850 Third Party Administrator Financial Statement along with the completed FIS 0865 form.
- After completing your form, ensure all information is accurate, and save any changes. You can then download, print, or share the form as needed.
Complete your FIS 0865 form online today to ensure a smooth renewal process.
To contact the state of Michigan, you can visit their official website, which has comprehensive contact information for various departments. For specific inquiries related to legal forms or state services, the FIS 0865 - State Of Michigan - Michigan can guide you to the right resources. If you require assistance in finding the appropriate forms, uslegalforms offers a user-friendly platform to help you connect with the necessary information.
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