36 Phone: 601-359-9055 Fax: 601-576-2546 Website: www.sos.ms.gov This form is designed to be completed online, printed, and mailed to our Office. This form may not be submitted online. A faxed copy of this form may not be submitted, unless approved in advance. This form must be notarized and submitted WITH the appropriate fee. A registration of a Preneed Establishment in Mississippi is valid for one (1) year from March 31st of the current year. Establishments seeking to have their registration r.
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How to fill out the MS 10PN001 online
The MS 10PN001 is designed for individuals and businesses seeking to register or renew their preneed establishment in Mississippi. This guide provides a clear and supportive walkthrough on how to successfully complete the form online.
Follow the steps to fill out the MS 10PN001 form accurately.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Section A: Establishment information. Fill in your full legal business name, preneed registration number, mailing and physical addresses, phone and fax numbers, email address, website address, and contact person details. If space is insufficient, attach additional pages as necessary.
- List all branch locations and preneed sales agents affiliated with your establishment. Ensure to include their respective contact information.
- Indicate the type of preneed funding used (trust, insurance, combined, warehouse receipt) and provide requisite details for trust officers or insurance carriers if applicable.
- Section B: Annual report. Enter the number of preneed contracts sold and their total retail value across funding types from the previous calendar year. Provide the trust account balance as of December 31 of the prior year.
- For Section C: Attestation, initial the boxes that reflect your understanding of the rules regarding contract forms and funding management.
- Section D: Preneed agent registration. Complete this section only if updating agent information. Indicate whether you are adding, dropping, or changing an agent's details.
- Finally, complete Section E: Certification and notarization. Obtain the required signature from an authorized officer, ensuring notarization follows the specified guidelines.
- Once all sections are filled, review the form for accuracy. Save changes, download, print, or share the completed form for submission.
Complete your MS 10PN001 registration online today.
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