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PDF Declaration of Legal Ward as Eligible Dependent 2026
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- Click ‘Get Form’ to open the PDF Declaration of Legal Ward as Eligible Dependent in our platform.
- Begin by filling in your personal information as the Health Insurance Subscriber. Enter your last name, first name, Z number, and social security number in the designated fields.
- Next, provide details for each enrolled dependent. Complete a separate form for each dependent by entering their last name, first name, Z number, and social security number.
- In the Declaration section, read through the requirements carefully. Confirm that you meet all IRS criteria for your dependent's eligibility by checking the appropriate boxes.
- Sign and date the declaration at the bottom of the form to certify that all information is accurate and complete.
- Finally, save your completed form using our platform’s save feature and return it to the LANL Benefits Office via fax or email as instructed.
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