How do I fill this out? To fill out the application form, first, download and print it from our website.To calculate your premium payments, use the attached Schedule of Rates and worksheet. Section II Who is An Insured is amended to. Include as an additional Insured the person(s) or organizellon(s) shown in the Schedule, but only. INSTRUCTIONS: If you were cited for an insurance violation and are submitting proof of insurance, complete this form and attach a copy of your insurance policy. Provides referrals for people who need assistance gaining access to healthcare, food, shelter, childcare and education resources available. Medicare has established guidelines for filling out the CMS 1500 form. How to fill out the Proof of Insurance Letter Template for Policyholders? Please fill out the following form: COPE Form.