Fidelity fax number for forms
[DOCX File]DCF-F-5178-E Voluntary Repayment Agreement
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Provider Contact Telephone Number and email address ... ☐ ☐1.I hereby authorize and direct the vendor Fidelity National Information Services (FIS) and the Department of Children and Families (DCF) to debit the amount above from the bank account registered with FIS, due to the reason indicated above. ... fax or mail within 10 days to: Insert ...
[DOC File]Annual Rate Filing Certification
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Mar 30, 1999 · The Bureau of Property and Casualty Forms and Rates would like to clarify what lines of business are covered by the aforementioned Statute and Rule. ... The statute excludes all other commercial property and casualty insurance as well as Fidelity and Surety. ... Company Contact Person: Title: Phone Number: 6. Provide your FAX number: 800 number ...
[DOCX File]DANE COUNTY CCS PROVIDER APPLICATION - Department …
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Staff qualified under DHS 36.10(2)(g) 1. to 8. which includes: psychiatrists, physicians, psychiatric residents, psychologists, licensed independent clinical social workers, professional counselors and marriage and family therapists, adult psychiatric and mental health nurse practitioners, and advanced nurse prescribers shall participate in at least one hour of either clinical supervision or ...
[DOC File]Choices: Custom Resources for American Government
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Title: Choices: Custom Resources for American Government Author: image Last modified by: VLEARCA Created Date: 2/14/2008 10:02:00 PM Company: Pearson
[DOC File]INSURANCE AND INDEMNIFICATION GUIDELINES FOR CITY …
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Telephone: (775) 687-3193 Fax: (775) 687-3195 This manual does not address all contracts, but is intended to address the most common situations. Be sure to contact Risk Management and/or the Attorney General’s Office if you have any questions on the material contained herein or need guidance on insurance requirements for specific contracts.
[DOC File]This form should be completed in block capitals by the ...
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When complete [Please fax the form to Fidelity on: +44 1737 837 751.] or [Please email to Fidelity at: dcadministration@fil.com] Section A – Participant details This section should be completed in block capitals by local company representative.
[DOC File]FIDELITY SECURITY LIFE INSURANCE COMPANY
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Underwritten by Fidelity Security Life Insurance Company CO Policy No. Application for Vision Care Benefits I. EMPLOYER INFORMATION Employer Name: Tax ID #: DBA Name (if other than above): Business Address: City: State: Zip: Mailing Address (if other than above): City: State: Zip: Principal Contact: Title: Phone: Fax: E-mail: Type of Business ...
[DOC File]Exhibit 5-3: Acceptable Forms of Verification
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Acceptable Forms of Verification Appendix 3: Acceptable Forms of Verification Factor to be Verified Acceptable Sources ... For a fee, additional information can be obtained from The Work Number 800-996-7556; First American Registry 800-999-0350; and Verifax 800-969-5100. Fees are valid project expenses.
[DOC File]FIDELITY SECURITY LIFE INSURANCE COMPANY
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Underwritten by Fidelity Security Life Insurance Company LA Policy No. Application for Vision Care Benefits I. EMPLOYER INFORMATION Employer Name: Tax ID #: DBA Name (if other than above): Business Address: City: State: Zip: Mailing Address (if other than above): City: State: Zip: Principal Contact: Title: Phone: Fax: E-mail: Type of Business ...
Fidelity National Title - New York
212.481.5858 · 1 800.287.3552 / Fax 212.481.8747 ... Fidelity National Title. Insurance Company of New York. Insurance Schedule. Number Company Amount Term Expires Premium Due Seller Remarks Mortgage Memorandum. Amount Mortgage Held by Principal Payable Interest Rate
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