Get the free Dependent Certification Form - brandeis

This form is used to confirm the full-time student status of dependents covered under the Delta Dental plan, ensuring eligibility for coverage as overage dependents.

How to fill out dependent certification form

How to fill out Dependent Certification Form

1. Obtain the Dependent Certification Form from your HR department or relevant authority.
2. Fill in your personal information at the top of the form, including your name and employee ID.
3. List all dependents you wish to certify, providing their full names, dates of birth, and relationship to you.
4. Attach any required documentation that supports each dependent's status, such as birth certificates or marriage licenses.
5. Review the form for accuracy and completeness, ensuring all required fields are filled.
6. Sign and date the form at the bottom to certify the information provided is true.
7. Submit the completed form to your HR department or the designated office as instructed.

Who needs Dependent Certification Form?

1. Employees who wish to add dependents for benefits coverage.
2. Individuals applying for certain benefits that require proof of dependent status.
3. Employees seeking to verify applicable tax deductions for dependents.

For pdfFiller’s FAQs

What is Dependent Certification Form?

The Dependent Certification Form is a document used to verify the eligibility of dependents for health insurance or other benefits.

Who is required to file Dependent Certification Form?

Individuals who are enrolling dependents in a benefits plan, such as an employee's spouse or children, are required to file the Dependent Certification Form.

How to fill out Dependent Certification Form?

To fill out the Dependent Certification Form, you need to provide personal information for each dependent, including their names, dates of birth, and relationship to the employee, and sign the form to certify the information provided is accurate.

What is the purpose of Dependent Certification Form?

The purpose of the Dependent Certification Form is to ensure that only eligible dependents receive benefits and to prevent fraud in benefits enrollment.

What information must be reported on Dependent Certification Form?

The information that must be reported on the Dependent Certification Form typically includes the dependent's full name, date of birth, Social Security number (if applicable), relationship to the employee, and any required documentation to support the dependent's eligibility.