 |
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| Group Application |
Group Application |
| Enrollment Form |
Enrollment Form |
| Medicare Card |
Proof of Worker's Comp Coverage |
| Proof of Chamber/Association Membership |
Proof
of Chamber Membership |
Employee Roster
(if less than 5 persons) |
|
| Personal Tax Filing (Federal 1040) |
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| Copy of W2's if income listed on Line 7 of 1040 |
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Business Tax Filing:
Most recent Federal Tax filing (personal 1040 and respective business), including
all relevant schedules, attachments and W2's. |
Copy of ONE of the following: Schedule C
Schedule 1065
Schedule F
|
Corporation/Subschapter S Corporation include:
Schedule 1120 or 1120S (first and second page) |
If Corporation/Subschapter S Corporation:
Copy of Schedule 1120 or 1120S |
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. |
Copy of ONE of the following:
Federal Tax ID # verification, such as Federal letter, Form #941 or Form #8109
coupons.
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.
Partnership Papers |
Business less than one year old:
May submit a Form 941, 1040 ES or Form 8109 in lieu of an annual tax schedule. |
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| Check for First Months' Premium |
Check for First Months' Premium |
| |
Must sign up for Electronic Funds Transfer for monthly premiums |
