Hr218 Application PDF Details

Completing the HR-218 Application Form is a critical step for members of the Fraternal Order of Police (FOP) looking to obtain legal defense coverage, signaling an essential aspect of preparation and protection for those in law enforcement roles. The form requires detailed personal information, including name, address, phone number, Social Security Number (last four digits), city, date of birth, state, FOP ID number, zip code, employment status, and FOP lodge affiliation. Applicants must decide between paying the annual rate of $50.00 via check or credit card, with an option for automatic policy renewal. The form underscores the importance of maintaining FOP membership in good standing to qualify for benefits and mandates applicants to certify compliance with the Law Enforcement Officers Safety Act (LEOSA) requirements. This includes, for active law enforcement officers, having arrest powers, agency authorisation to carry a firearm, and meeting firearm qualification standards. Retired officers must have served with arrest powers, retired in good standing after at least 15 years (or have retired due to a duty disability), and obtained state certification within the past 12 months for carrying firearms. The thorough completion of this form, coupled with adherence to LEOSA prerequisites, ensures eligibility for coverage, demonstrating the form's crucial role in safeguarding law enforcement officers' rights and well-being.

QuestionAnswer
Form NameHr218 Application
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameshow do i apply for hr218, hr 218 form, hr 218 application, florida hr 218 application form

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HR-218 Application

Name: ___________________________________________

Address: __________________________________________

Phone Number: ____________________________________

__________________________________________

SSN (Last Four Digits): _____________________________

City: ______________________________________________

Date of Birth: ______________________________________

State: _____________________________________________

FOP ID Number: ___________________________________

Zip Code: __________________________________________

FOP Lodge Name: __________________________________ FOP Lodge Number: _________________________________

Employment Status:

_______ Active

_______ Retired

Annual Rate: $50.00

 

 

Payment Information

 

 

____________

I wish to pay by check

(If paying by check, make payable to: FOP Legal Plan, Inc. and submit

 

 

 

to the address listed at the bottom of this form)

____________

I wish to pay by credit card

(If paying by credit card, complete all information listed below.)

 

VISA _________________

Mastercard_________________

 

Card Holder Name ______________________________________________________________________

 

Card Number ____________________________________________ Exp. Date ____________________

 

_______

By checking this box we will automatically renew your policy and deduct payment from

 

 

your account, unless otherwise notified.

Note: Coverage effective dates are the first of every month. Completed applications and payment must be received by Hylant Group on or before the last business day of any month for coverage to start the 1st day of the following month. Applications not fully and accurately completed may result in ineligibility for, and non-payment of benefits.

You must be an FOP member in good standing to participate and be eligible for benefits. Any person who is subsequently determined not to be eligible to participate or to receive benefits as of the date a claim arises, will not receive payment of benefits.

By submitting this form you are certifying that you meet all of the requirements set forth in LEOSA. If you are currently employed as a law enforcement officer by a governmental agency, LEOSA requires, among other things, that you must have powers of arrest, be authorized by the agency to carry a firearm and have met all agency standards to qualify in the use of a firearm. If you are retired as a law enforcement officer from a public agency, LEOSA requires, among other things, that you must have had powers of arrest while employed, must have retired in good standing after a minimum of 15 years of service (or have a duty disability), and MUST HAVE BEEN ISSUED A CERTIFICATION BY YOUR STATE DURING THE MOST RECENT 12 MONTHS stating that you meet state standards applicable to active law enforcement officers for carrying firearms. Not fulfilling these requirements and others set forth by LEOSA will result in no coverage.

FOP Legal Defense Plan | c/o Hylant Group | P.O. Box 1687 | Toledo, OH 43603

Phone: 800-341-6038 | Fax: 419-255-7557 | Email: lynn.young@fop.net

How to Edit Hr218 Application Online for Free

Our PDF editor that you may take advantage of was developed by our leading web programmers. One could complete the hr218 permit file immediately and without problems applying our software. Merely keep up with the guide to start out.

Step 1: You should hit the orange "Get Form Now" button at the top of the page.

Step 2: Now you are going to be within the file edit page. You'll be able to add, enhance, highlight, check, cross, include or erase areas or phrases.

The next parts will frame the PDF document that you will be creating:

stage 1 to completing how do i get my hr 218

In the If paying by check make payable to, I wish to pay by credit card, If paying by credit card complete, VISA, Mastercard, Card Holder Name, Card Number Exp Date, By checking this box we will, Note Coverage effective dates are, You must be an FOP member in good, and By submitting this form you are area, note the information you have.

stage 2 to finishing how do i get my hr 218

The system will demand for further information with the intention to automatically prepare the box FOP Legal Defense Plan co Hylant.

how do i get my hr 218 FOP Legal Defense Plan co Hylant fields to fill out

Step 3: Click the button "Done". Your PDF form is available to be exported. It is possible to save it to your device or email it.

Step 4: Create a duplicate of each separate form. It's going to save you time and assist you to stay clear of challenges in the future. Also, your information is not shared or viewed by us.

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