Dga Change Form PDF Details

Last week, the Department of Game and Inland Fisheries (DGIF) released an updated version of the Form 5300.1 - Conservation Easement Certification form. This new form was created to streamline the certification process for landowners who donate a conservation easement to the Commonwealth of Virginia. The updated form is now available on the DGIF website and must be used by all landowners applying for a donation of a conservation easement to the Commonwealth on or after January 1, 2018. The new form is three pages long, compared to the six-page old form. It has been simplified and streamlined to make it easier for landowners to complete. Some of the changes include: - removing expired authorization language;

QuestionAnswer
Form NameDga Change Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdga change of residence, change of address forms printable, vsp form to change doctors mailing address, dga change

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CHANGE OF ADDRESS FORM

Complete this form to change your address with our office. Return this form to us by mail to

Address Change Dept, DGA–Producer Pension & Health Plans, 5055 Wilshire Blvd, Ste. 600,

Los Angeles, CA 90036 or fax it to (323) 653-3560. If you have any questions, you can call (877) 866-2200 and ask for our Address Change Department.

1) Participant Information

PARTICIPANT NAME (Please print)

S.S.#

or

BIRTHDATE

2) Mail Preferences & Address Information

You may choose to receive all your mail at one address or you may have Pension mail sent to one and Health sent to the other. Check the appropriate box to indicate where you want your mail sent. (Only one address can be selected for each type of mail.)

ALL = Send both Pension & Health Mail to this address.

P = end only Pension mail to this address. Examples of Pension correspondence include: Summary Plan Description Booklet, Annual and Quarterly Statements, Retirement Benefits, and 1099s.

H = end only Health mail to this address.

Examples of Health correspondence include: Summary Plan Description Booklet,

 

Open Enrollment Information, Health Plan Coverage Cards, Premium Billing, and Claims.

 

 

PRIMARY RESIDENCE

Mail Preference: ALL P H

ADDRESS LINE 1:

LINE 2:

LINE 3:

HOME PHONE:

CELL

PHONE:

FAX:

LINE 4:

E-MAIL:

OTHER ADDRESS*

Mail Preference: ALL P H

INDICATE ADDRESS TYPE:

(Ex.: Business Mgr., Accountant, Attorney, Personal Business, 2nd Residence, etc.)

FIRM

NAME:

ADDRESS LINE 1:

LINE 2:

LINE 3:

LINE 4:

CONTACT:

PHONE:

ADD’L.

PHONE:

FAX:

E-MAIL:

*For security reasons, if you want the Plans to provide confidential information to a Third Party, please complete a Third Party Authorization Form.

3) Special Instructions

Use this space for an additional mailing address or for special mailing instructions.

4) Signature

PARTICIPANT’S SIGNATURE

(Required)

DATE

REMINDER: The DGA-Producer Pension & Health Plans is a separate entity from the Directors Guild of America (DGA). You must notify the DGA separately of your address change. Their address is 7920 Sunset Blvd., Los Angeles, CA 90046; phone (310) 289-2000 / (800) 421-4173.

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Step no. 1 in submitting opm retiree change of address form

2. Once the prior part is done, proceed to type in the applicable details in all these: ADDRESS LINE, LINE, LINE, LINE, PHONE, ADDL PHONE, FAX, EMAIL, For security reasons if you want, Special Instructions, Use this space for an additional, Signature, PARTICIPANTS SIGNATURE, Required, and DATE.

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