Benefit Forms
Benefit Forms include the following:
Request Basic or add Life Coverage: complete when requesting life insurance
Life Insurance Beneficiary Form: this form verifies who receives life insurance payment
Pre-Retirement Death Benefit Beneficiary Form: this form verifies who receives pre-retirement payment
Health Insurance Form: complete to add or change health insurance coverage
Dental Insurance Form: complete to add or change dental insurance coverage
Salary Reduction Agreement Form: complete to adjust amount being withheld from check regarding 403B deduction. This can only be done January, July and September.
Business Office Fax #:
207-839-5003
