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Fixed Percentage Option Election - Franco Signor 2026
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- Begin by entering the liability insurance settlement amount in the designated field. This is crucial as it sets the basis for your fixed payment option.
- Next, specify your payment amount, which should be 25% of the total settlement. Ensure this figure is accurate to avoid any discrepancies.
- Fill in your personal details including Beneficiary Name, Date of Incident, Medicare Number, and Date of Settlement. These fields are essential for processing your election.
- Provide a brief description of your injuries in the space provided. Be concise yet thorough to ensure clarity.
- Review the certification statements carefully and confirm that they apply to your situation by checking the appropriate boxes.
- Indicate whether you are including a check or money order for payment or if you will pay upon receiving a bill. Fill in the relevant amounts as necessary.
- If applicable, check if you are signing on behalf of a beneficiary and ensure you have submitted valid proof of representation.
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