Pebtf forms 36 2026

1. Click ‘Get Form’ to open the PEBTF Forms 36 in the editor.
2. Begin by entering the Commonwealth employee’s name and number in the designated fields. Ensure accuracy as this information is crucial for verification.
3. Next, input the Commonwealth employee’s date of birth, followed by the spouse/domestic partner’s name and date of birth.
4. Indicate whether your spouse/domestic partner is employed by selecting 'Yes' or 'No'. Repeat this for part-time and full-time employment status.
5. Sign the form in the Employee’s signature section to validate your submission.
6. For employer representatives, fill in the company name and answer questions regarding health insurance availability and enrollment status for the spouse/domestic partner.
7. Complete any additional fields regarding eligibility dates and provide your signature along with your title, date, and telephone number.

Start filling out your PEBTF Forms 36 online for free today!