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Click ‘Get Form’ to open it in the editor.
Begin by clearly printing the subscriber's name, including last name, first name, and middle initial. Enter the ETF Member ID or Social Security Number.
Fill in the current mailing address, and if applicable, check the box indicating a change of address.
Specify the health plan name and indicate whether you have prescription drug coverage elsewhere by selecting 'Yes' or 'No'. If 'Yes', provide the plan name.
Complete the table with names, birth dates, Medicare claim numbers, and effective dates for all insured individuals under your group health insurance policy. If not eligible for Medicare, write 'not eligible'.
Sign and date the form to attest that all information is accurate. Ensure that your signature is from the subscriber only.
Start filling out your etf form 4307 online for free today!
Withdrawal claims are accepted and processed at the following offices of the Board : Head Office. MEHEWARA PIYESA, Narahenpita, Colombo 5. Statutory Benefits - EMPLOYEES TRUST FUND BOARD EMPLOYEES TRUST FUND BOARD statutory-benefits EMPLOYEES TRUST FUND BOARD statutory-benefits
Is there a deadline for submitting an ETF claim form?
No benefits will be paid if this claim form is received by ETF more than 12 months after the last day for which you were paid by your employer. A claim may be submitted up to 30 days prior to the last day worked in cases of scheduled surgery or impending childbirth.
What is an ETF form?
An ETF is an exchange-traded investment product that must register with the SEC as an open-end investment company (or sometimes as a unit investment trust). ETFs are similar to mutual funds.
How do I claim my ETF?
The member must have a bank account in his/her name or jointly. A photocopy of the bank passbook or statement showing such details as the bank name, branch, account number, account-holders address and national identity card [NIC] number, etc. should be attached to the claim application.
What happens after I submit the ETF claim form?
ETF will direct deposit your benefit payment approximately 30-60 days after receiving your completed application. Processing time varies, depending on the volume of applications and when we receive the final earnings report from your employer. This information is usually reported after your last paycheck.
form 4307
Etf form 4307 templateEtf form 4307 pdfEtf form 4307 instructionsETF WIETF its your choice 2025Wi ETF MedicareWisconsin department of Employee trust funds FormsETF portal
Complete this form to provide your Medicare information to ETF. If you do not have a copy of your Medicare card you should still submit the form and send a
Complete the Medicare Eligibility Statement (ET-4307) and submit to ETF. Your State Group Health Insurance retiree premium will decrease once submitted.
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