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Click ‘Get Form’ to open the Disbursement Sheet in our editor.
Begin by entering the total amount received from the insurance company in the designated field. Ensure you include the date of receipt for accurate record-keeping.
In the 'Disbursed As Follows' section, list each disbursement made. For each entry, provide a brief description and the corresponding amount. This helps maintain clarity on how funds are allocated.
Calculate and enter the total disbursed amount at the bottom of this section. Double-check your entries to ensure accuracy.
Fill in the balance disbursed to the relevant party, ensuring that it reflects any remaining funds after disbursements have been accounted for.
Finally, complete the verification statement by entering your name and signing it digitally within our platform. Include the date to finalize your document.
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CERTIFICATE OF INSURANCE INSURED Name Address City, State, Zip This certificate is issued as a matter of information only and confers no rights upon the certificate holder - schoolcounselor
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