Dd form 2854 2010-2025

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253 votes

The document is a TRICARE Plus Disenrollment Request form, which provides instructions for individuals wishing to disenroll from the Military Health System's TRICARE Plus program. It includes sections for personal information, reasons for disenrollment, and requires a signature to certify the accuracy of the provided information. The document also outlines privacy considerations and where to submit the completed form.

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Click ‘Get Form’ to open the dd form 2854 2010 in the editor.
Begin with Section I, where you will enter the Sponsor Information. Fill in the Sponsor's Social Security Number, Name, and Date of Birth accurately.
Proceed to Section II for Individual(s) Requesting Disenrollment. Enter the names and dates of birth for each individual requesting disenrollment. Select the reason for disenrollment by marking an 'X' next to the appropriate option.
In this section, also provide a requested disenrollment date and contact numbers (home and work) for each individual listed.
Finally, navigate to Section III. Here, sign and date the application to certify that all information provided is true and complete.
Once completed, save your changes and submit your form directly through our platform or print it out for submission to your Military Treatment Facility.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (143 Votes)
2014	4.2 Satisfied (49 Votes)
2010	4.3 Satisfied (253 Votes)

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