Are you a manager or an employer in charge of managing employees' benefits? If so, you know that the fund forms for these types of packages can be complicated and time consuming. Streamlining this process is key to ensuring your company's funds are managed effectively. That's why we've created our Management Benefits Fund Form – a simplified way to handle your employee benefit payments without having to worry about the paperwork! Read on to learn how the form works and how it will make administering benefits easier.
| Question | Answer |
|---|---|
| Form Name | Management Benefits Fund Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | management benefits fund, management benefits fund forms, nyc management benefits fund, city of new york management benefits fund |
OFFICE OF LABOR RELATIONS
Management Benefits Fund
40 Rector Street, Third Floor, New York, N.Y. 10006
Tel: (212)
nyc.gov/olr
DEPENDENT ELIGIBILITY FORM FOR YOUNG ADULT CHILDREN (AGES
This form only can be used to enroll young adult dependents (ages
MEMBER INFORMATION
LAST NAME: |
FIRST NAME: |
|
|
MI:
SOCIAL SECURITY#:
AGENCY NAME:
ADDRESS (NUMBER AND STREET):
APT:
CITY:
STATE:
ZIP CODE:
DEPENDENT INFORMATION
Deinition of dependent: Dependent children include natural and adopted children, and children for whom you are the legal guardian, up to age 26. Please note that there are no inancial dependency, residency, student status or marital status requirements for dependents.
|
SOCIAL SECURITY NUMBER: |
DATE OF BIRTH: |
|
RELATIONSHIP: |
|
|
|
|
/ |
/ |
|
|
|
|
|
|
|
|
|
|
1. |
LAST NAME: |
|
|
FIRST NAME: |
|
MI: |
|
|
|
|
|
|
|
|
I AM ATTACHING THE FOLLOWING AS PROOF OF DEPENDENCY: ❑ BIRTH CERTIFICATE |
❑ ADOPTION AGREEMENT |
❑ COURT ORDER ESTABLISHING GUARDIANSHIP |
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
SOCIAL SECURITY NUMBER: |
DATE OF BIRTH: |
|
RELATIONSHIP: |
|
|
|
|
/ |
/ |
|
|
|
|
|
|
|
|
|
|
2. |
LAST NAME: |
|
|
FIRST NAME: |
|
MI: |
|
|
|
|
|
|
|
|
I AM ATTACHING THE FOLLOWING AS PROOF OF DEPENDENCY: ❑ BIRTH CERTIFICATE |
❑ ADOPTION AGREEMENT |
❑ COURT ORDER ESTABLISHING GUARDIANSHIP |
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
SOCIAL SECURITY NUMBER: |
DATE OF BIRTH: |
|
RELATIONSHIP: |
|
|
|
|
/ |
/ |
|
|
|
|
|
|
|
|
|
|
3. |
LAST NAME: |
|
|
FIRST NAME: |
|
MI: |
|
|
|
|
|
|
|
|
I AM ATTACHING THE FOLLOWING AS PROOF OF DEPENDENCY: ❑ BIRTH CERTIFICATE |
❑ ADOPTION AGREEMENT |
❑ COURT ORDER ESTABLISHING GUARDIANSHIP |
|||
|
|
|
|
|
|
|
MEMBER SIGNATURE
I certify that my dependent(s) meets the requirements for eligibility as a dependent and that all of the above information is correct.
SIGNATURE:
MBF ADMINISTRATIVE OFFICE USE ONLY
DATE:
/ /
PROCESS DATE |
PROCESSED BY |
APPROVAL DATE |
||
/ |
/ |
|
/ |
/ |
|
|
|
|
|
/ |
/ |
|
/ |
/ |
OLR/FORMS/DEF_FORM.INDD 1/11