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City of Baltimore Office of Employee Benefits 7 E. Redwood Street, 20th Floor Baltimore, MD 212022021RETIREE BENEFITS ENROLLMENT FORM QUALIFIED FAMILY LIFE EVENTS INSTRUCTIONS DATE: Name: Date of
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Start by writing your first name in the space provided.
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Next, write your last name in the space provided.
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Finally, write your date of birth in the format of month, day, and year.

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Name and date of birth are typically required in various situations, including but not limited to:
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- Maintaining records and providing identification in various administrative processes
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Name date of birth refers to the full legal name and the date of birth of an individual, often required in official documents and forms.
Individuals who are applying for government benefits, school enrollment, employment, or any legal processes may be required to file their name and date of birth.
To fill out name date of birth, write your full legal name followed by your date of birth in the specified format (e.g., MM/DD/YYYY) as directed on the form.
The purpose of providing your name and date of birth is to verify your identity and age for legal and administrative processes.
You must report your full legal name and date of birth, and occasionally other identifying information such as your Social Security number or address.
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