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and 
Before proceeding to the Group Insurance Beneficiary Form, PLEASE
read the following directions; failure to complete and return the form correctly
will delay your sign up. Direct any questions to one of the Benefits
Fund Trustees.
- Complete the Employee Information Section online.
- Complete the Beneficiary Information Section online.
- Complete the Alternate Beneficiary Information
Section online.
- Submit and print the completed form by clicking
the "Submit and Print" button on the bottom of the form. When
your printer dialogue box appears, select the appropriate printer and click
"Print".
- Sign and date the form.
- Return your completed form to Norma
Chrisman in PH 220.Interoffice envelopes
should be addressed to: Library - Norma Chrisman.
Now that you know what to do, click
here to complete the form! Thank you on behalf of the PA Benefits
Trust Fund Committee.
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