Annuity surrender request - MetLife

Annuity surrender request ... No 2. Did your insurance agent recommend (advise) you to surrender your annuity contract? Yes. NoNote: If you answered "No" to Question 1 above and "Yes" to Question 2 above, the state of Florida requires that we first provide you with important disclosure information. We are unable to send your

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Group Dental Dental expense claim - MetLife

Dental expense claim . Metropolitan Life Insurance Company. SECTION 1: To be completed by Employee ... You must sign the claim form in item 21. 4. You can arrange for MetLife to make payment directly to the dentist by completing item 22. If you wish ... MetLife will review the claim

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Series L Variable Investment Option Performance Update

invest in Portfolios of the underlying Trust that were in existence prior to the Sub-Account inception date, these returns have been adjusted to reflect the charges and expenses of the Series L Variable Annuity, as if the contract had existed during the stated period(s), including all Portfolio-level expenses, the Mortality & Expense and

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Series VA Variable Investment Option Performance Update

that invest in Portfolios of the underlying Trust that were in existence prior to the Sub-Account inception date, these returns have been adjusted to reflect the charges and expenses of the Series VA Variable Annuity, as if the contract had existed during the stated period(s), including all Portfolio -level expenses, the Mortality & Expense and

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Request for electronic transfer of funds (EFT) - MetLife

Annuities Request for electronic transfer of funds (EFT) This form is provided for your convenience in setting up electronic funds transfers. Metropolitan Life Insurance Company

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TRICARE Dental Program Credit Card/Electronic Funds ...

TRICARE DENTAL PROGRAM Credit Card/Electronic Funds Transfer (EFT) Authorization Metropolitan Life Insurance Company, New York, NY SECTION I NOTE: Incomplete information will delay your authorization.

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Facilities Reference Guides on e-forms

Facilities Reference Guides (FRGs): For General Dentists: ... • Texas Facility Reference Guide For Specialists: • California Facility Reference Guide • Florida Facility Reference Guide • New Jersey Facility Reference Guide • New York Facility Reference Guide • Texas Facility Reference Guide . Title: Microsoft Word - Facilities ...

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Annuity withdrawal/surrender - MetLife

withdrawal or surrender. This form is not available for 1035 Exchanges or Annuitization. • If this is a TSA contract, we will require the “Individual Tax Sheltered Annuity 403b Distribution Withdrawal

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Full policy surrender request - MetLife

Full policy surrender request . Use this form to request a full surrender and termination of your life insurance policy (ies). Metropolitan Life Insurance Company Metropolitan Tower Life Insurance Company. Things to know before you begin • Social Security or Tax ID number is required in Section 2.

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SCHEDULE OF BENEFITS - MetLife

Customer Service (800) 880-1800 D2530 Inlay - metallic - three or more surfaces $245 D2543 Onlay - metallic - three surfaces $260 D2544 Onlay - metallic - four or more surfaces $300

AGENT/BROKER OF RECORD CHANGE - First Choice Insurance ...

insured's signature date title (if applicable) company name (if applicable) fax (a/c, no): phone (a/c, no, ext): address: e-mail ... policy number(s) effective date expiration date named insured line of business (as it appears on policy) city of insured state of insured zip code of insured street address of insured. acord@ created date: 5/23 ...

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Life Insurance Change of Beneficiary

First name Middle name Last name Individual Life Insurance Life Insurance Change of Beneficiary ... Payment to the Issue of a Deceased Child (Per Stirpes): If a child of the Insured is named as a Beneficiary and that child dies before the Insured, that child's share of the proceeds will be paid to that child’s living children in

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AGENT/BROKER OF RECORD CHANGE - First Benefits …

NAMED INSURED LINE OF BUSINESS (AS IT APPEARS ON POLICY) Please be advised that we wish to name as our exclusive representative effective for the lines of business shown above, currently in force or submitted by application. PRODUCER CODE # DATE INSURED'S SIGNATURE DATE This authorization replaces any other authorization that may have been

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HOME HEALTH INTAKE AND REFERRAL FORM

Name of policy holder/named insured: _____ Relationship to patient: _____ _____ No. 5. If you have GHP coverage based on your spouse’s current employment, does your spouse’s ... coordination period starts the first day of the month an individual is eligible for Medicare (even if

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Standing Delivery Order - USPS

As the above-named individual or firm, I authorize the agent(s) named below to receive all mail addressed to or in care of the above-named individual or firm, including these services; Adult Signature Required, Certified, Insured, C.O.D., Priority Mail Express ® , Signature Confirmation ™ , and unrestricted Registered Mail .

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How to Read an Insurance Policy - Sector Source

insured becomes legally obligated to pay due to a claim first made against the insured during the policy period because of a wrongful act.” As you read the policy, you must research the definitions of insured, loss, claim, policy period, and wrongful act to determine if the policy will cover the incident and for whom.

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Designation of Beneficiary Form

Last Name First Name Relationship to Insured Date of Birth (MM/DD/YYYY) Address of Beneficiary (Address, City, State, ZIP) Benefit Percentage (%) Percentage Total: 100% Secondary Beneficiary Designation-Employer Paid Coverage Last Name First Name Relationship to Insured Date of Birth (MM/DD/YYYY) Address of Beneficiary (Address, City, State ...

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8721; VGLI Beneficiary Designation/Change

COMPLETE IF A TRUST HAS BEEN NAMED AS A BENEFICIARY IN SECTION 2. 1. Trustee Name: (First, MI, Last) Address: Complete this section if you have named a trust as a primary or secondary beneficiary in Section 2. Fill in the name and address for each trustee. Fill in the title and date of the Trust Agreement in the space provided.

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GROUP TERM LIFE INSURANCE BENEFICIARY DESIGNATION

SECTION 1: About the Insured. First name Middle name Last name Date of birth (mm/dd/yyyy) Social Security number Phone number Address City State ZIP Employer name Customer number. SECTION 2: About the Plan . The beneficiaries you name on this form apply only to the MetLife-insured plan(s) selected below: All group term life coverage currently ...

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Beneficiary Designation Form - MetLife

insurance coverage insured by MetLife. • To name additional beneficiaries, attach a separate page. Provide the requested information including the beneficiary type (primary or contingent) and the % proceeds for each. Sign and date these page(s), making sure the date is the same as the date next to the signature on this form.

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