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Home > Insurance Division > Doctors' Corner > Medical Malpractice Liability Insurance Premium Assistance Fund Application
2006 Application Medical Malpractice Liability Insurance Premium Assistance Fund
Applications should have been filed online no later than 5 p.m. EDT Friday, August 24, 2007 to have been considered timely
Instructions 
   

IMPORTANT: One of the requirements for receiving this subsidy was the submission of a State of New Jersey W-9 Questionaire Form. This questionaire must have been completed, signed and returned to the New Jersey Department of Banking and Insurance BEFORE you or your designated payee could receive the subsidy. The W-9 form cannot be filed online. The person who will receive the 2006 subsidy payment (either you or your designated payee) should have submitted the W-9 Questionnaire form no later than Friday, August 24, 2007.

PLEASE NOTE:

Even if the Department of Banking and Insurance determines that you are eligible for the 2006 subsidy, the State Treasurer will not process our request for a payment to you (or your designated payee) without a W-9 on file with their office.

If you or your designated payee previously received a premium subsidy paid in either 2005 and/or 2006, another W-9 is not necessary for the 2006 premium subsidy paid in 2007. The New Jersey State Treasury office already has your payee information on file.

The W-9 form is not the application for the 2006 subsidy paid in 2007.


     
More Information   View our Frequently Asked Questions
MMLIPA Fund
NJ Department of Banking and Insurance
PO Box 325
Trenton, NJ 08625-0325
  Telephone: 609-292-3100


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New Jersey Department of Banking and Insurance