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CERTIFICATION OF HEALTH CARE PROVIDER FOR FAMILY MEMBERS SERIOUS HEALTH CONDITION (FAMILY AND MEDICAL LEAVE ACT) Adapted from Form WH380F Revised June 2020 Expires 6/30/2023SECTION EMPLOYER Either

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How to fill out certification of family members

01

Obtain the certification form for family members from the relevant authority or organization.

02

Fill out all required personal information for each family member including their full name, date of birth, relationship to you, and any other relevant details.

03

Provide any supporting documentation if necessary, such as birth certificates or marriage certificates.

04

Sign and date the certification form to affirm the accuracy of the information provided.

05

Submit the completed certification form to the appropriate entity for processing.

Who needs certification of family members?

01

Individuals who are required to provide proof or documentation of their family members for reasons such as insurance coverage, immigration applications, or legal matters.

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What is certification of family members?

Certification of family members is a form or document that verifies the relationship between an individual and their family members for various purposes such as benefits, insurance, or legal matters.

Who is required to file certification of family members?

The individuals who are required to file certification of family members are typically the primary account holders of benefits or insurance policies.

How to fill out certification of family members?

To fill out a certification of family members, one must provide the required information about themselves and their family members, including names, dates of birth, and relationship to the primary account holder.

What is the purpose of certification of family members?

The purpose of certification of family members is to authenticate the relationships between individuals and their family members for official or legal purposes.

What information must be reported on certification of family members?

The information that must be reported on certification of family members includes names, dates of birth, and relationship to the primary account holder for all family members.

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