This form is an Assignment of Money Due. The assignor agrees to grant to the assignee all title and interest in a certain debt or money due as described in the agreement. The form also provides that it is the responsibility of the assignor to collect the debt.
Assignment Due Form For Lic Policy In San Diego
Category:
State:
Multi-State
County:
San Diego
Control #:
US-00422
Format:
Word;
Rich Text
Instant download
Description
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By signing this form, you are giving permission for all Contract Providers for the County of San Diego, to bill your insurance for services rendered. Date. Instructions: • Type or print legibly in ink.Return to Human Resources - Benefits Division, 5530 Overland Avenue, Suite 210. Step 1 - Print and Complete Form. To fill out this form, first gather all necessary personal and organizational information beforehand. (2) The full name, and age, of the Assignee must be stated. (3) The actual consideration for the assignment received from the assignee should be written in. 7999 Personnel Procedures: c Emergency Lockdown Procedure, Flier Approval Process, Nondiscrimination Statement, Sexual Harassment, Student Cell Phone Use.
