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Click ‘Get Form’ to open the beneficiary form template in the editor.
Begin by filling out your Member Information. Enter your full name, SSN or Member ID, and current address clearly in ink.
In the Primary Beneficiary Designation section, list one or more primary beneficiaries. Include their full legal names, Social Security Numbers, dates of birth, relationships to you, and addresses.
If applicable, designate Contingent Beneficiaries by providing the same information as for primary beneficiaries. Remember that contingent beneficiaries will only receive benefits if all primary beneficiaries are unavailable.
Finally, sign and date the form at the bottom. Ensure your signature is original as it is required for processing.
Once completed, mail the form to EGID at the specified address provided in the instructions.
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This form must be completed and mailed to the appropriate Personnel Office. The designation must be received prior to the death of the participant or former.Read more
PRIMARY BENEFICIARY(IES): Person or persons who will receive the life insurance proceeds upon your death. Name. Date of birth. Social security no. Address.Read more
Jun 1, 2011 To view the eMedNY-000301 claim form, see Appendix A. The displayed claim form is a sample and is for illustration purposes only. AnRead more
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