Home Address Change Request (USA)
If you know your TotalAccess password, do not use this form. If you do not know your password, mail or fax this completed form to the address listed below. Once the update has been made, a new TotalAccess password will be mailed to you at your new home address. The password and your BEMS ID* are very important because you will be required to provide both whenever you use TotalAccess via the phone or external internet (www.boeing.com/express).
*BEMS ID is an identification number assigned by Boeing to use in place of your SSN. You must provide your BEMS ID on this form. If you do not know your BEMS ID, please contact TotalAccess at 1-866-473-2016 and say “BEMS ID” when prompted.
1.Name (please print): (First) _____________________ (Middle) _______________ (Last) ___________________________
2.BEMS ID (*see instructions above if BEMS ID is not known): ____________________________________________________
3. Birth Year: _________________ |
4. Phone: (_________) _____________ - _________________________ |
5.Old Address (street, city, state, zip): ___________________________________________________________________
6.New Address (street, city, state, zip): __________________________________________________________________
7.Email Address (to send confirmation of update): __________________________________________________________
8.Is the person completing this form the same person that is listed in section 1?
Yes - Proceed to section 9
No - You must be the Authorized Agent (Power of Attorney, Conservator or Guardian) of the named person and have approved documentation on file with Boeing. If you are, enter your name here, and proceed to section 9. If not, go to www.boeing.com/poa and follow the guidelines for submitting the documentation for approval first. Once approved, you may then proceed with this change of address form. Note: If agents must act jointly, then all agents must sign the form.
Authorized Agent Name (please print): _______________________________________________
9. Signature of above named person or their Authorized Agent (sign in front of notary – see section 10) Signature: __________________________________________________ Date: __________________________
10.Signature Authentication Requirement (to be completed by Notary Public)
On this, the _____ day of _______, 20____, before me, a notary public (the undersigned officer), personally appeared:
(print name of person appearing before the notary) _________________________________________. This person is known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that s/he executed the same for the purposes therein contained. In witness hereof, I hereunto set my hand and official seal.
Notary signature: _________________________________
Printed name: ____________________________________ |
|
Notary for the state of: _____________________________ |
|
My commission expires: ____________________________ |
(Notary seal/stamp) |
11. Mail or fax completed form to: The Boeing Company, 11808 Miracle Hills Drive, Omaha, NE 68154 Fax: (402) 970-0238
For questions, call TotalAccess at 1-866-473-2016 or go to www.boeing.com/addresschange.
Note: If this form is incomplete or something needs clarification, you may be contacted by TotalAccess.
IMPORTANT: A new state or locality may change your health insurance coverage and/or require a change in tax withholding status or deductions.
X36217 REV (19 MAY 2017)
