Additional (endorsement)
Endorsement for Additional Premium or Additional Policy Premium. The revised calculations should be performed using the MeritMaster portal to see proposed revised payment schedule and print Additional contract. This is a communications upload for your ease of process.
Agent Name
First Name
Last Name
Insurance Brokerage
*
Agent Email
*
agent@brokerinsurance.ca
Merit Account Number
*
Insured Name
*
For identification purposes only
Amount of Additional Premium
including tax and any policy fees
Effective Date of Additional
-
Month
-
Day
Year
Date
Down Payment
Please Select
Under $500 threshold, no down payment applies
Merit to Collect down payment on initial scale
Broker Collected Down Payment
Adjust to Minimum Retained Plus Policy Fee
Seeking adjustment
If Agent Collected Down Payment, Amount of Down Payment Collected
Upload Dec Page and or Invoice or other Documentation Supporting Additional
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Cancel
of
Upload Signed or Unsigned Confirmation of Additional from MeritMaster
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This is the Additional Addendum Contract Form
Cancel
of
Any specific details, requests or needs related to this Additional. If Requesting Merit to Collect Down Payment, this may include a specific date requested for withdrawal.
Manual Additional Generation
Please Select
Yes
No
Secure Send
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