The Michigan Multiple Carrier Redemption Form (fill-in form) is a form used by Michigan residents to claim a refund on their insurance premiums. This form is available in two types: the standard form and the premium-only form. The standard form is used to claim a refund on both premiums and benefits while the premium-only form is used to claim a refund on premiums only. This form allows Michigan residents to submit multiple insurance carriers’ information at once. It requires the insured to provide their name, address, date of birth, Social Security Number, and other information. Additionally, the form also requires the insured to provide information about the insurance carriers they have used and the policies they have purchased. The form also allows the insured to request a refund on all or part of their premiums. Upon completion, the insured must submit the form to the Michigan Department of Insurance and Financial Services.