SBM Prepaid Legal Plan Annual Confirmation Form









ACOP Form (Pensioner's Reply)

SOCIAL SECURITY SYSTEM. ANNUAL CONFIRMATION OF PENSIONERS. PEN-01405 (04-2019). PENSIONER'S REPLY. THIS FORM MAY BE REPRODUCED AND IS NOT FOR SALE.
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Collaborator Annual Confirmation Form

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Reconfirmation_SOP Standard Operating Procedure on the

1 juin 2020 If used the annual reconfirmation forms must be duly signed by the OIE Delegate and be supplied in electronic format to the Director General of ...
EN SOP Reconfirmation


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PLEASE READ INSTRUCTIONS AND REMINDERS AT THE BACK BEFORE FILLING OUT THIS FORM. PRINT ALL INFORMATION IN CAPITAL LETTERS. AND USE BLACK INK ONLY.
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ANNUAL CONFIRMATION OF PENSIONERS. PEN-01406 (04-2019). CERTIFIED BY SSS OFFICIAL/REGULAR EMPLOYEE. THIS FORM MAY BE REPRODUCED AND IS NOT FOR SALE.
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English September 2021 REPORT OF THE VIRTUAL MEETING OF

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ACOP FORM - NEW

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SOCIAL SECURITY SYSTEM ANNUAL CONFIRMATION OF

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SBM Prepaid Legal Plan Annual Confirmation Form

PREPAID LEGAL PLAN ANNUAL CONFIRMATION. Pursuant to the Michigan Rules of Professional Conduct all prepaid legal plans operating in the State.
PPL Annual Confirmation Form


216930 SBM Prepaid Legal Plan Annual Confirmation Form

Page 1 of 2 STATE BAR OF MICHIGAN

PREPA ID

LEGAL PLAN

ANNUAL

CONFIRMATION

Pursuant

to the Michigan Rules of Professional Conduct, all prepaid legal plans operating in the State

of Michigan must file with the State Bar of Michigan a written plan that discloses: (1) the name under

which the plan operates; (2) the name, address, and telephone number of its chief operating officer; and (3) the plan terms, condition of eligibility, schedule of benefits, subscription charges, and agreements with counsel. Also, in January of each year following inception, every prepaid legal plan m

ust submit a statement to the State Bar that it continues to do business under the terms and condition

reflected in its previous annual filings as amended to date. Updated filings must be submitted to the State Bar within thirty (30) days of any material change to the terms and conditions of the plan and/or any material change to the information previously provided. In accordance with MRPC 6.3, please complete this

Annual Confirmation and send it via e-mail or

regular mail to the State Bar of Michigan using the contact information listed below:

State Bar of Michigan

Attention:

Ms. Janna

Sheppard

Administrative Assistant

306 Townsend

S treet

Lansing, MI

48933

1.Name o

f the prepaid legal plan (If your program operates under more than one name, a separate confirmation form MUST be completed for each plan):

2.Name of the chief operating officer of the plan:

Address:E-Mail Address:

Phone

Number:

3.Nam e of the sponsoring organization responsible for operating the plan:

Page 2 of 2

4. Statement of Continuity (No material change)

If your prepaid legal plan continues to do business under the terms and condition reflected in its last filing, please complete the statement below: I, _________________________________, certify that the plan entitled ________ _ _______ _______ __ _____ _____ __ continues to do business under the terms and conditions reflected in its last filing with the State Bar of Michigan in ________________ 20 __. I also affirmatively state that there ha ve not been any material changes to the terms and conditions of the plan and/or the service since the last filing in ________________, 20__.

5. I, ________________________________, certify that the information provided on

this Prepaid Legal Plan Annual

Confirmation form is true and accurate.

Signature of person

completing this form: Please type or print the name and title of the person completing this form:

Name of

your employer:

Address:

Page 1 of 2 STATE BAR OF MICHIGAN

PREPA ID

LEGAL PLAN

ANNUAL

CONFIRMATION

Pursuant

to the Michigan Rules of Professional Conduct, all prepaid legal plans operating in the State

of Michigan must file with the State Bar of Michigan a written plan that discloses: (1) the name under

which the plan operates; (2) the name, address, and telephone number of its chief operating officer; and (3) the plan terms, condition of eligibility, schedule of benefits, subscription charges, and agreements with counsel. Also, in January of each year following inception, every prepaid legal plan m

ust submit a statement to the State Bar that it continues to do business under the terms and condition

reflected in its previous annual filings as amended to date. Updated filings must be submitted to the State Bar within thirty (30) days of any material change to the terms and conditions of the plan and/or any material change to the information previously provided. In accordance with MRPC 6.3, please complete this

Annual Confirmation and send it via e-mail or

regular mail to the State Bar of Michigan using the contact information listed below:

State Bar of Michigan

Attention:

Ms. Janna

Sheppard

Administrative Assistant

306 Townsend

S treet

Lansing, MI

48933

1.Name o

f the prepaid legal plan (If your program operates under more than one name, a separate confirmation form MUST be completed for each plan):

2.Name of the chief operating officer of the plan:

Address:E-Mail Address:

Phone

Number:

3.Nam e of the sponsoring organization responsible for operating the plan:

Page 2 of 2

4. Statement of Continuity (No material change)

If your prepaid legal plan continues to do business under the terms and condition reflected in its last filing, please complete the statement below: I, _________________________________, certify that the plan entitled ________ _ _______ _______ __ _____ _____ __ continues to do business under the terms and conditions reflected in its last filing with the State Bar of Michigan in ________________ 20 __. I also affirmatively state that there ha ve not been any material changes to the terms and conditions of the plan and/or the service since the last filing in ________________, 20__.

5. I, ________________________________, certify that the information provided on

this Prepaid Legal Plan Annual

Confirmation form is true and accurate.

Signature of person

completing this form: Please type or print the name and title of the person completing this form:

Name of

your employer:

Address:


  1. sss form for annual confirmation of pensioners