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The CIC 2134 form is a significant document associated with the Good Student Discount offered by Commerce Insurance. This form is designed specifically for policyholders who wish to apply for discounts based on their students’ academic performance. To qualify, the student must meet certain academic criteria, which include being in the upper 20% of their class or maintaining a minimum grade point average, typically a "B" or equivalent across various grading systems. The form requires information about the student, including their name, school, and class standing, as well as details about the named insured and producer. The certification process involves a school official who verifies the student’s academic achievements, ensuring authenticity and compliance with the discount policies. For home-schooled students, there are specific options available for certification, offering flexibility to parents regarding the submission of their child’s academic performance. Overall, the CIC 2134 form not only facilitates potential financial benefits for families but also underscores the importance of academic excellence in obtaining such rewards.

Cic 2134 Example

COMMERCE INSURANCE, 211 MAIN STREET, WEBSTER, MASSACHUSETTS 01570 (508) 943·9000

GOOD STUDENT DISCOUNT FORM

Named Insured

 

Producer Name:

Mailing Address

 

Producer Code:

City/State

Zip Code

Policy Effective Date:

STUDENT INFORMATION

StudentName: --------------------------------------

School Class: Freshman ___ Sophomore ____ Junior __ Senior __

SCHOOL INFORMATION

School Name and Address:

ACADEMIC CERTIFICATION (To be Completed by School Official)

For the academic period immediately preceding this certification, the student noted above has met one of the following requirements:

__ Is in the upper 20% of his or her class scholastically; OR

__ Maintains a "B" average or higher, or its equivalent, or if the letter grading system cannot be average then no grade is below a "B"; OR

__ Maintains a numerical grade point average or "3.0", in a system assigning numerical grade points of 4.0, 3.0, 2.0, and 1.0; OR

__ Was included on the "Dean's List", "Honor Roll", or comparable list indicating scholastic achievement.

Date

Name and Title of School Official

Signature of School Official

ACADEMIC CERTIFICATION - HOME SCHOOLED STUDENTS

For Home Schooled students, two certification options are available:

__ Attach a standardized form certified by a 3rd party organization showing evidence that one of the above listed qualifications has been satisfied; OR

___ Attach evidence of the student scoring in the upper 20% on an annual national standardized exam.

CIC-2134 {4/09)

Form Characteristics

Fact Name Description
Form Purpose The CIC 2134 form is used to apply for a good student discount on a car insurance policy.
Insurer Information Commerce Insurance, located at 211 Main Street, Webster, Massachusetts, 01570.
Contact Number For inquiries, the contact number is (508) 943-9000.
Insured Requirements The form requires information on the Named Insured and Producer, including contact details.
Student Eligibility Students must indicate their class status: Freshman, Sophomore, Junior, or Senior.
Academic Certification Certification of academic performance must be completed by a school official.
Eligibility Criteria To qualify, students must meet specific academic criteria, such as being in the upper 20% of their class or maintaining a "B" average.
Home Schooled Students Alternative certification options are provided for home-schooled students.
Submission Date The form must be completed and signed, with a date provided by the school official.
Governing Law This form is subject to Massachusetts insurance regulations.

Guidelines on Utilizing Cic 2134

After gathering the necessary information and documents, you're ready to fill out the Cic 2134 form. Follow these steps carefully to ensure all sections are completed accurately.

  1. Complete the Named Insured and Producer Section: Fill in the name of the insured, the producer's name, and the mailing address. Make sure to include the city, state, and zip code. Also, input the producer code and policy effective date accurately.
  2. Provide Student Information: Enter the student's name and select their class from the options provided: Freshman, Sophomore, Junior, or Senior.
  3. Fill Out School Information: Write the name and address of the school the student attends.
  4. Complete Academic Certification: If you’re a school official, indicate the criteria met by the student (upper 20% of the class, "B" average, 3.0 GPA, or inclusion on the Dean's List). Add the date, the school official's name and title, and their signature.
  5. For Home Schooled Students: Choose one certification option. Either attach a standardized form certified by a third party or evidence of the student's performance on a national standardized exam.

Once everything is filled out, review the form to ensure all information is correct. Make copies for your records before submitting it as required. Your prompt submission will help facilitate the processing of the discount request.

What You Should Know About This Form

What is the purpose of the CIC 2134 form?

The CIC 2134 form is designed to verify a student's academic performance for the Good Student Discount offered by Commerce Insurance. This discount is available to policyholders who have a student in their household that meets specific academic criteria. By completing this form, policyholders can help ensure they receive the appropriate discount on their insurance policy based on the student's scholastic achievements.

What information is required on the CIC 2134 form?

To complete the CIC 2134 form, several key details are needed. The named insured must provide their information, including mailing address and policy effective date. Additionally, student information is required, such as the student's name, school, and classification (e.g., freshman, sophomore, junior, or senior). The form also requires academic certification, which must be completed and signed by a school official, verifying the student meets the necessary criteria for the discount.

How can home-schooled students qualify for the discount?

Home-schooled students can qualify for the Good Student Discount through two distinct options on the CIC 2134 form. The first option is to attach a standardized form certified by a third-party organization that demonstrates the student meets the required academic qualifications. The second option allows for the inclusion of evidence that the student scored in the upper 20% on an annual national standardized exam. Either option will suffice for meeting the academic verification requirements.

Who is responsible for completing the academic certification section?

The academic certification section of the CIC 2134 form must be completed by a qualified school official. This can include a principal, teacher, or other designated representative who can accurately confirm the student’s academic standing. Their signature and title are essential to validate the information provided. This ensures the integrity of the certification process and helps maintain the standards for the Good Student Discount.

Common mistakes

Filling out the CIC 2134 form can be a straightforward process, yet many individuals inadvertently make mistakes that can jeopardize their chances of receiving discounts. Understanding these common pitfalls is essential for a successful application.

One prevalent mistake is neglecting to enter accurate student information. For instance, failing to clearly write the name of the student or not indicating the correct school year can create unnecessary setbacks. Complete all fields in a clear, legible manner. The importance of precision in this section cannot be overstated; it serves as the foundation for the eligibility verification process.

Another frequent error occurs when individuals provide inadequate or unclear school information. Some applicants may rush through this section, omitting essential details like the school name or address. Always ensure that this information is complete and precise. A discrepancy between the details provided and the school’s records can lead to significant delays or denials.

Misunderstanding the academic certification requirements is also a common miss. The form presents several options to qualify academically, and failing to select the appropriate one or misunderstanding what each entails can result in a rejected application. It’s crucial to take the time to thoroughly review your academic standing and to check which criteria you satisfy before marking a selection on the form.

For home-schooled students, there is an additional layer of complexity. Submitting documents without proper certification can be a major mistake. Ensure that you either attach evidence from a third-party organization or provide the results of standardized testing that confirm eligibility. Be meticulous about this process; the inclusion of the correct documentation is non-negotiable.

Many applicants overlook the necessity of a school official’s signature. This certification is vital for the form’s acceptance. Leaving this section unsigned or failing to include a title next to the official's name can result in the rejection of the application. Always double-check that this essential part is completed properly.

Lastly, overlooking the deadline associated with the form can spell disaster. Failing to submit the CIC 2134 Form within the designated timeframe may result in the loss of potential discounts. Set reminders and plan to complete the form well in advance of the due date to avoid last-minute stress.

By sidestepping these common mistakes, individuals can increase their chances of a smooth process and ultimately enjoy the benefits of the Good Student Discount. Awareness and attention to detail are key allies in filling out the CIC 2134 form correctly.

Documents used along the form

When applying for the Good Student Discount through the Cic 2134 form, several other documents can support your application. Each one plays a unique role in ensuring your eligibility for this discount. Here’s a list of important forms that are often used alongside the Cic 2134:

  • Proof of Enrollment: A document like a current school transcript or enrollment verification letter confirms that the student is actively enrolled in school.
  • Grade Reports: This can include copies of report cards or transcripts, showing the student’s grades for the relevant academic period.
  • Standardized Test Scores: For home-schooled students, standardized test results can demonstrate that they meet the academic qualifications required for the discount.
  • Certification from a School Official: A form completed by a teacher or administrator confirming the student's academic standing. This can be attached if the school does not provide a transcript.
  • Home School Affidavit: This document verifies that the student is receiving a home-school education and may need to outline the educational curriculum.
  • Dean’s List or Honor Roll Certificates: If applicable, providing official recognition of academic achievement can bolster the application.
  • Third-Party Organization Certification: For home-schooled students, this can be a standard form confirming that one of the academic requirements has been met, as recognized by a reputable organization.

These documents work together to provide the necessary proof of academic excellence. Collecting and submitting them along with the Cic 2134 form can make the process smoother. Take the time to gather these materials, and you’ll be one step closer to securing your Good Student Discount.

Similar forms

  • Good Student Discount Certificate: Similar to the CIC 2134 form, this document serves to provide evidence of a student's academic performance to qualify for discounts on insurance rates. Both forms require details about the student and the academic institution.

  • Insurance Policy Application: This document includes information about the insured, similar to the CIC 2134. While the primary focus is on acquiring insurance, it may also request academic information if applicable to specific discounts.

  • Proof of Enrollment Letter: This is a formal document used to verify a student's enrollment status at an educational institution. Like the CIC 2134, it often needs to be signed by a school official to be considered valid.

  • Academic Transcript: An academic transcript provides a record of a student’s grades and overall performance at school. Both the transcript and CIC 2134 reflect the academic achievements necessary for discount eligibility.

  • Home School Affidavit: For home-schooled students, this document attests to the educational standards met by the student. The CIC 2134 requires similar verification to establish eligibility for student discounts.

  • Dean's List Certification: This document certifies a student’s achievement of being on the Dean's List, similar to the academic certification section of the CIC 2134 that acknowledges scholastic excellence.

Dos and Don'ts

When filling out the CIC 2134 form, it's important to follow specific guidelines to ensure accuracy and compliance. Here are some key dos and don'ts.

  • Do provide accurate personal information, including your name and school details.
  • Do check the eligibility criteria carefully to ensure you meet at least one of the academic requirements listed.
  • Do have a school official complete the certification section to confirm your academic standing.
  • Do attach any required documentation, especially for home-schooled students.
  • Don't leave any sections of the form incomplete; ensure all fields are filled accurately.
  • Don't submit the form without double-checking for spelling errors or incorrect information.

Misconceptions

  • It’s only for high school students. The CIC 2134 form can also be used for home-schooled students and those attending alternative educational programs.
  • Only academic grades are considered. While grades are important, the form also allows for alternative forms of academic achievement, such as being on the Dean’s List or Honor Roll.
  • Any school official can sign the certification. The certification must be signed by an authorized school official, which means the person must have the proper authority to certify academic achievements.
  • It can be submitted at any time. There are deadlines for submitting the CIC 2134 form, so it’s important to check the specific dates to ensure eligibility for the good student discount.
  • Home-schooled students don’t have to provide proof. Home-schooled students must still attach documentation, either from a third-party organization or standardized test results, to complete the form.
  • Maintaining a “B” average means you qualify automatically. Achieving a “B” average is one requirement, but all criteria must be reviewed to determine eligibility for the discount.
  • Once qualified, eligibility lasts forever. Students must maintain their academic standing yearly to keep receiving the good student discount. Regular re-evaluation is necessary.

Key takeaways

The CIC 2134 form is used to apply for a good student discount from Commerce Insurance. It is essential to follow the instructions carefully to ensure your submission is valid.

  • Named Insured: Make sure to enter the correct name of the insured individual.
  • Producer Information: Include the name, address, and code of the insurance producer.
  • Policy Effective Date: Write the date when the insurance policy becomes effective.
  • Student Information: Clearly indicate the student’s name and class standing.
  • School Information: Provide the complete name and address of the school the student attends.
  • Academic Certification: This must be signed by a school official. The student must meet one of the academic criteria listed.
  • Home Schooled Students: For home-schooled students, certifications must be attached to prove academic achievement.
  • Documentation: Ensure all required documents, such as standardized test scores, are included for proper evaluation.
  • Submission: Send the completed form to the address specified at the top of the document.
  • Deadlines: Check for any submission deadlines to ensure timely processing.