 |
|
Group Application |
|
Enrollment Form |
|
Medicare Card |
|
Proof of Chamber/Association Membership |
Employee Roster
(if less than 5 persons) |
|
Personal Tax Filing (Federal 1040) |
|
Copy of W2's if income listed on Line 7 of 1040 |
Business Tax Filing:
Most recent Federal Tax filing (personal 1040 and respective business), including all relevant schedules, attachments and W2's. |
Corporation/Subschapter S Corporation include:
Schedule 1120 or 1120S (first and second page) |
Copy of ONE of the following:
Federal Tax ID # verification, such as Federal letter, Form #941 or Form #8109 coupons.
State license
Certification (such as DBA with embossed seal on front and County Clerk's stamp on back)
Articles of Incorporation stamped "FILED" by the State of Michigan. |
Business less than one year old:
May submit a Form 941, 1040 ES or Form 8109 in lieu of an annual tax schedule. |
|
Check for First Months' Premium |
|
|
