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- Click ‘Get Form’ to open the uben 100 2012 form in the editor.
- Begin by filling out Section 1, 'Personal Information.' Enter your name, Social Security number, former campus/lab location, and retirement system coverage. Ensure all details are accurate.
- In Section 2, select the appropriate action regarding your plan(s). Choose to enroll, change, or cancel as needed. Provide any relevant dates for marriage or other significant events.
- Proceed to Section 3 where you will indicate your choices for medical, dental, and legal plans. Check the boxes for enrollment or cancellation as applicable.
- Complete Section 4 by listing yourself and all eligible family members. Use the relationship codes provided to specify each member's connection to you.
- Finally, sign and date the form in Section 5. Review all entries for accuracy before submitting.
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