
Ame Social Security Number * Date of Birth Address City State Name of Insurance Company ZIP Code Policy Number Address City State ZIP Code Provide Information to this County Social Services Office * In compliance with the Federal Privacy Act of 1974, disclose of the social security number is voluntary and it is requested for identification purposes. Failure to disclose this information will not affect participation in this program. Client Signature Date TO BE COMPLETED BY THE INS.
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How to fill out the ND DHS SFN 363 online
The ND DHS SFN 363 form is used to request verification of life insurance policy information from the North Dakota Department of Human Services. This guide provides clear, step-by-step instructions for completing the form online to ensure accurate submission.
Follow the steps to fill out the ND DHS SFN 363 online.
- Press the ‘Get Form’ button to access the ND DHS SFN 363 form and open it in the editor.
- Begin by filling in your personal details in the 'To be completed by the client' section. This includes your name, social security number, date of birth, address, city, state, and ZIP code.
- Next, provide information about your insurance policy. Specify the name of the insurance company and the policy number. Include the insurance company's address, city, state, and ZIP code.
- Indicate the county social services office to which the information should be sent. Your social security number is requested for identification purposes, but disclosing it is voluntary.
- Sign and date the form in the 'Client Signature' section to confirm that the information provided is accurate.
- In the section for the insurance company, ensure that the company provides the needed details such as the type of policy, face value, name of insured, and any premium information.
- Respond to the question of whether premiums have been paid by someone other than the policy owner or the insured. If so, include their name and the amount.
- Complete additional details regarding cash surrender value, annuitization status, payment frequency, payment amounts, and any guaranty period if applicable.
- Finally, verify that the form has been completed accurately, and ensure that all relevant sections are filled out. The insurance company should provide verification by including their title, telephone number, and fax number.
- Once you have completed the form, you can save the changes, download, print, or share the form as required.
Complete your ND DHS SFN 363 online today to streamline your verification process.
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