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Affidavit of Disabled DependentOffice use only Approved by:Approved date:Effective date:Use this affidavit to affirm disabled dependent eligibility. See the Summary Plan Description for more information
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How to fill out pebb affidavit of domestic

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How to fill out pebb affidavit of domestic

01
Obtain the PEBB Affidavit of Domestic Partnership form.
02
Fill in the personal information section for both partners, including full names, addresses, and contact information.
03
Provide information about the nature of your domestic partnership, including how long you have been together and your commitment to each other.
04
Both partners must sign and date the form in the presence of a notary public or witnesses as required by your state's laws.
05
Submit the completed form to the appropriate office or agency as instructed.

Who needs pebb affidavit of domestic?

01
The PEBB Affidavit of Domestic Partnership is typically needed by partners who wish to establish their domestic partnership for the purpose of accessing benefits or rights provided by their employer or a government agency.
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PEBB affidavit of domestic is a form used to report domestic partnership and dependents for Public Employees Benefits Board (PEBB) coverage.
Employee or retiree who has a domestic partner or dependent that they wish to cover under PEBB benefits is required to file pebb affidavit of domestic.
To fill out pebb affidavit of domestic, one must provide personal information, information about the domestic partner or dependent, and sign the form.
The purpose of pebb affidavit of domestic is to add a domestic partner or dependent to the employee's or retiree's PEBB benefits coverage.
Information such as names, dates of birth, and relationship to the employee or retiree must be reported on pebb affidavit of domestic.
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