Capitol Payment Plan New Jersey Payment Deferral Request Form
I hereby certify that (1) I am an individual and am experiencing a financial hardship due to COVID-19, or (2) I am an authorized representative of the business submitting this request form, and the business is experiencing a financial hardship due to COVID-19. In accordance with the State of New Jersey, Department of Banking and Insurance Bulletin No. 20-17, I am requesting a deferral of the installment payments due under my premium finance agreement as described below. I understand the payment deferrals do not change the terms of the premium finance agreement nor is this temporary relief a forgiveness of the installment payments.