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Foresters General Leasing Remittance Sheet ON

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Foresters General Leasing Remittance Sheet ON Powered By Docstoc
					Rate Table Used:                                                                                                                                   Please send remittance to:
                                                                                                                                                                   PO Box 15
                                                                                                                                                                   991 Hornby St.
                                                                                                                                                    Vancouver, B.C. V6Z 1V3
                                                  General Leasing Group Creditor Insurance
                                                     Single Premium Remittance Sheet
Dealer #:                         Dealership Name:                                                                        Completed by:

  Month:                         Dealership Address:                                                                             Telephone:

                                                                         LifePlus                    Disability      Gross       Ontario PST       Less Retained   Premium & Tax
            Name                  Certificate #        Life Premium                  C.I. Premium
                                                                                                                                                    Commission
                                                                        Premium                      Premium       Premium          8%                                Remitted
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0               0               0
                                                                                                                             0                 0
      Please make cheque payable to:               %                  Total commission retained by dealership:                                                 0
      Foresters Life Insurance Company                                Total premium & tax remitted (where applicable):                                                         0
                                                                      (Gross Premium minus <Retained Commission> plus 100% of Tax = Remittance Amount)


                   Please note: Remittances are due no later than the 10th day of the following month in which business was written.
                                                    For assistance please call: 1-888-799-2472
Rate Table Used:                                                                                                                       Please send remittance to:
Commission %:                                                                                                                                         PO Box 15
                                                                                                                                                         991 Hornby St.
                                                                                                                                         Vancouver, B.C. V6Z 1V3
                                                   General Leasing Group Creditor Insurance
                                                     Monthly Premium Remittance Sheet
Dealer #:                           Dealership Name:                                                                    Completed by:

  Month:                          Dealership Address:                                                                        Telephone:

                                                        Void Cheque                   LifePlus                  Disability   Monthly Gross   Insurance    Total Ontario
            Name                   Certificate #                      Life Premium               C.I. Premium
                                                                                                                               Premium
                                                              #                      Premium                    Premium                         Term         PST 8%
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                                                      0                               0
                                                                                                          %                  Commission owed to dealer :
                                                                                                                             (Commission does not include taxes)
                   Please note: Remittances are due no later than the 10th day of the following month in which business was written.
                                                    For assistance please call: 1-888-799-2472
St.




       Commission
      due to dealer

                 0
                 0
                 0
                 0
                 0
                 0
                 0
                 0
                 0
                 0
                 0
                 0
                 0
                 0
                 0
                 0
                 0
                 0
                 0
                 0
                 0
                 0

				
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posted:4/9/2012
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