HomeMy WebLinkAboutInv# 20210501 - LIFE INSURANCE COMPANY OF NORTH AMERICA - 04/26/2021 (2)Form 1
Premium Remittance Support
City of Dania Beach
City of Dania Beach
100 W. Dania Beach Boulevard
Dania Beach, FL 33004 Client ID
32008
Due Date Billing Account ID
05/31/2021 1234
Bill Reference Coverage period
1234_050121 05/01/2021 - 05/31/2021
Product Product Code Benefit
Type
Policy
Number
Current
Amount
Adjustment
Amount Total Due
Basic Term Life BTL Basic SGM610429 $1150.08 $0 $1150.08
Voluntary Term Life VTL Voluntary SGM610429 $2874.35 $0 $2874.35
Basic AD&D BACC Basic SOK607690 $134.56 $0 $134.56
Grand Total $4158.99 $0 $4158.99
Please print and include this summary page with your payment. Be sure to write the Bill Reference number on your
check.
Remit Payment to:
Life Insurance Company of North America
PO Box 782447
Philadelphia, PA 19178-2447
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