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GEBA - Government Employees' Benefit Association geba
 
Forms

General
Automatic Debit Form
Cancellation Form
Change of Member Information Form
Reduction in Coverage Form
2009 Insurance Premium Due Dates and Automatic Debit Payments Schedule
2010 SRP Contribution and Withdrawal Schedule
2010 SRP Automatic Debit Contribution Schedule
Retirement/Resignation Form
GEBA/GEMBA 2010 Summary Plan Description

SRP Designation of Beneficiary Form

Domestic Partners
GEBA Declaration of Domestic Partnership
GEBA & Unum Life Insurance Declaration of Domestic Partnership

2010-2011 GEBA Foundation Scholarship
GEBA will begin accepting applications for the 2010-2011 Scholarship Foundation in January 2010. Please visit this website for more information or call (301) 688-7912 or (800) 826-1126

Term Life Insurance Plan

Term Life Insurance Policy (Updated: March 2009)
Enrollment Form
Evidence of Insurability Form
Term Life Beneficiary Designation Form

Long Term Disability Plan
Enrollment Form

Long-Term Care Insurance Plan
Inquiry/Quote Request Form

Professional Liability Insurance
Enrollment Form

Emergency Travel Plan
Enrollment Form
Visitee Update Form
Claim Form
Physician's Statement

Vision Benefits Plan
Enrollment Form

Dental Insurance
Enrollment Form
Delta Dental Claim Form
Basic Plan - Evidence of Coverage
Enhanced Plan - Evidence of Coverage

Variable Annuity Contract*
MetLife Contribution Form
MetLife Withdrawal Form
MetLife Performance Sheet
MetLife Asset Builder Prospectus
MetLife Interfund Transfer Form
SRP Beneficiary Designation Form
2010 SRP Contribution and Withdrawal Schedule
2010 SRP Automatic Debit Contribution Schedule
Request to Re-characterize an IRA Contribution



Traditional/Roth IRA
TSP-70
Request to Re-characterize an IRA Contribution
SRP IRA Transfer Form
GEBA/GEMBA 2009 Summary Plan Description
Request for Roth IRA Conversion
2010 SRP Contribution and Withdrawal Schedule
2010 SRP Automatic Debit Contribution Schedule


Stable Value Account
Stable Value Account New Account Form
Stable Value Account Existing Investor Contribtion Form
SVA/GIC Group Annuity Withdrawal Form
SVA/GIC Traditional IRA/Roth IRA Withdrawal Form


Non-Qualified Group Annuity
1035 Exchange MetLife
2010 SRP Contribution and Withdrawal Schedule
2010 SRP Automatic Debit Contribution Schedule
Request to Re-characterize an IRA Contribution



GEBA MAX Fixed Annuity (Additional forms may be required for residents of certain states. Please contact the GEBA office at (301) 688-7912 or (800) 826-1126 for more information.)
GEBA MAX Fixed Annuity Application
GEBA MAX Withdrawal Form
GEBA MAX Transfer Form
GEBA MAX Service Request Form
GEBA MAX Statement Regarding Existing Policies or Contracts - Maryland
GEBA MAX Suitability Acknowledgement - Maryland
GEBA MAX Replacement Form - Maryland Residents Only
Replacement Form - Colorado Residents Only
Replacement Form - District of Columbia Residents Only
Replacement Form - Delaware Residents Only
Replacement Form - Florida Residents Only
Replacement Form - Maryland Residents Only



*For more information about MetLife Asset Builder, call or visit the GEBA office for a free prospectus. You should consider a fund's investment objectives, risks, charges and expenses carefully before investing. The prospectus will contain this and other information about the investment company. Please read the prospectus carefully before investing.

 

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Mailing Address P.O. Box 206 Annapolis Junction, MD 20701-0206 Ft. Meade Office: (800) 826-1126