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RETIREE BENEFITS STATEMENT FORM Retiree ID: Health Care and Benefits Division PO Box 200130 Helena, MT 59620-0130 RETIREE NAME RETIREE ADDRESS RETIREE CITY STATE ZIP INSTRUCTIONS & DEADLINE FOR ELECTIONS:

How to fill out retiree benefits statement form

How to fill out retiree benefits statement form:

1. Gather necessary information: Before filling out the form, gather all the required information such as personal details, retirement date, pension plan information, and any other relevant documents.
2. Read the instructions: Carefully review the instructions provided with the form. Make sure to understand the purpose of each section and the information required.
3. Provide personal details: Begin by filling in your personal information accurately, including your full name, address, social security number, and contact information.
4. Specify retirement details: Enter your retirement date, as well as any relevant details about your previous employment and retirement plan.
5. Provide beneficiary information: If applicable, include the necessary details of your beneficiaries who may be eligible for benefits after your passing. This could include their full names, relationship to you, and contact information.
6. Fill out financial information: Some retiree benefits statement forms may require you to declare your current financial status. Provide accurate details about your assets, pensions, investments, and any other relevant financial information.
7. Attach supporting documents: If the form requests any supporting documents, such as proof of retirement or beneficiary information, make sure to include them along with your completed form.
8. Review and double-check: Once you have completed the form, carefully review all the provided information. Double-check for any errors or missing details before submitting the form.
9. Submit the form: Follow the instructions provided on how to submit the retiree benefits statement form. This could involve mailing it to a specific address or submitting it online through a designated portal.

Who needs retiree benefits statement form:

1. Retirees: Individuals who have retired and are seeking to declare their eligibility for various retiree benefits, such as healthcare coverage, life insurance, or pension plans, may need to fill out a retiree benefits statement form.
2. Former employees: In some cases, individuals who have left their previous employment but are still eligible for certain benefits may need to complete a retiree benefits statement form. This allows them to declare their entitlement and provide necessary information for processing their benefits.
3. Beneficiaries: If a retiree wishes to designate beneficiaries to receive any eligible benefits after their passing, they may need to fill out a retiree benefits statement form to provide the necessary details of their beneficiaries.

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