We have identified the following overpayment and are in good faith voluntarily refunding all monies collected in error. Please download the form, complete each field and print.Include the form with your refund so we can properly apply the refund and record the receipt. Look at your settlement paperwork and see what the settlement amount is. If the check equals that amount, you may not have to pay them back. B. YES, Please provide a summary of your action plan to achieve the premium refund in response to this bulletin in the Explanatory Memorandum-section II. Make a list of the items you own.