Get the free PEBTF Annuitant Change Form (PEBTF-10). PEBTF Annuitant Change Form

Retired Employees Health Program Annuitant Change Form Title: Mr. Dr. Mrs. Ms. 1. Annuitant Demographics Name (Last, First, Mi) Home Telephone # () Street Address City State Alternate Telephone #

How to fill out pebtf annuitant change form

How to fill out PEBTF Annuitant Change Form:

1. Obtain the PEBTF Annuitant Change Form from the appropriate source. This form can usually be found on the PEBTF website or by contacting the PEBTF directly.
2. Complete the personal information section of the form, including your full name, address, contact information, and Social Security number. Ensure that all information is accurate and up to date.
3. Indicate the reason for the annuitant change by selecting the appropriate box on the form. Some common reasons may include marriage, divorce, death of a current annuitant, or a change in beneficiary.
4. Provide the requested details about the new annuitant or beneficiary, if applicable. This may include their full name, relationship to you, address, and contact information.
5. Ensure that any required supporting documentation is attached to the form. This could include marriage certificates, divorce decrees, or death certificates, depending on the reason for the annuitant change.
6. Review the completed form carefully to ensure accuracy and that all required fields have been completed. Make any necessary corrections or additions before submitting the form.
7. Submit the PEBTF Annuitant Change Form according to the provided instructions. This may involve mailing the form to a specific address or submitting it electronically through an online portal.

Who needs the PEBTF Annuitant Change Form?

1. Current annuitants who wish to change their designated beneficiary.
2. Annuitants who have experienced a life event such as marriage, divorce, or the death of the current annuitant and need to update their annuitant information.
3. Beneficiaries who need to provide updated information or claim their entitlement after the death of the annuitant.

It is important to note that the specific requirements and processes for filling out the PEBTF Annuitant Change Form may vary depending on the individual's unique circumstances and the guidelines provided by the PEBTF. Always consult the appropriate resources or contact the PEBTF directly for accurate and up-to-date instructions.

For pdfFiller’s FAQs

What is pebtf annuitant change form?

The PEBTF Annuitant Change Form is a form used to update information for a retired employee or their dependents in the Pennsylvania Employees Benefit Trust Fund system.

Who is required to file pebtf annuitant change form?

Retired employees and their dependents who are covered by the Pennsylvania Employees Benefit Trust Fund are required to file the PEBTF Annuitant Change Form.

How to fill out pebtf annuitant change form?

The PEBTF Annuitant Change Form can be completed online or submitted by mail. It requires information such as personal details, changes in coverage, and signatures.

What is the purpose of pebtf annuitant change form?

The purpose of the PEBTF Annuitant Change Form is to ensure that the PEBTF system has up-to-date and accurate information on retired employees and their dependents for benefits administration.

What information must be reported on pebtf annuitant change form?

The PEBTF Annuitant Change Form requires reporting of personal information, changes in coverage, dependent information, and any other relevant updates.

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