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  • Uft Welfare Fund's Dental Enrollment/transfer Form 2017

Get Uft Welfare Fund's Dental Enrollment/transfer Form 2017-2025

WELFARE United Federation of Teachers FUND 52 Broadway New York New York 10004 212 539-0500 DENTAL ENROLLMENT/TRANSFER FORM I choose D UFT Welfare Fund Scheduled Benefit Plan D Dentcare HMO D UFT Florida Dental Discount Plan permanent Florida residents only. Plan o Only one dentist may be selected for the entire family. o Relationship arne include last name if different from your last name Birth Date Mo/DayNr Sex Provider Name and Code umber Must be completed if selecting Dentcare HMO Spouse Child Upon completion of the Enrollment/Transfer Form please sign and mail it to the UFT Welfare Fund at the address aboveAttention DENTAL ENROLLMENT. D Retiree D Pre- 70 Retiree D COBRA Social Security Number Last Name First Name Middle Initial City State Home Street Address Work Phone Zip Code Marital Status D Single D Married D Widowed Divorced Home Phone Must complete D Domestic Partner Spouse/Domestic Partner s SS / / Is spouse/domestic partner a UFT member DYes D 0 Are you covered for dental ....

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232