New "Fillable" PDF Application for FAX Submission!
Applying For PCIP is Now Even Easier and Faster Than Ever!
The fillable PCIP/MRMIP PDF Application is now available for applicants, insurance agents/brokers and certified application assistants to fill out and print for fax submission.
The fillable PDF application includes a validation check to help ensure all fields with required information are completed. Once the application is complete, the application must be printed, dated and signed by the applicant, and agent/broker or CAA, if applicable.
After printing the fillable PDF application, the next step provides options to make the initial premium payment through the PCIP website or through an automated phone system.
Applicants may choose from the following payment options when submitting the fillable PDF application by fax:
- Visa – Credit/Debit Card
- MasterCard – Credit/Debit Card
- Discover Card – Credit Card
Once the initial premium payment has been made, the fillable PDF application is ready to be faxed to PCIP! Be sure to include your Application Fax Cover Sheet which prints out with the application.