Va Form 29 4125 is an application that Veterans can use to apply for education benefits. The form is used to apply for the following benefits: - Montgomery GI Bill-Active Duty (MGIB-AD) program - Montgomery GI Bill-Selected Reserve (MGIB-SR) program - Reserve Educational Assistance Program (REAP) - Marine Gunnery Sergeant John David Fry Scholarship. The form must be completed and submitted in order to receive any of the above mentioned education benefits.
You'll find information regarding the type of form you wish to submit in the table. It will show you how much time it takes to complete va form 29 4125, what fields you will have to fill in and several other specific facts.
Question | Answer |
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Form Name | Va Form 29 4125 |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | 29 form forms, va form 29 4125, form for one sum payment for veterans, department of veterns affairs sum payment |
OMB Approved No.
Respondent Burden: 6 Minutes
Expiration Date: 10/31/2022
CLAIM FOR ONE SUM PAYMENT
GOVERNMENT LIFE INSURANCE
1. INSURANCE FILE NUMBER
2. INSURANCE POLICY NUMBER
3. FIRST, MIDDLE, LAST NAME OF INSURED VETERAN
4. DATE OF DEATH
INSTRUCTIONS
WE NEED A PHOTOCOPY OF THE VETERAN'S DEATH CERTIFICATE OR A STATEMENT FROM THE ATTENDING PHYSICIAN SHOWING DATE AND CAUSE OF DEATH. ONLY ONE CERTIFICATE OR STATEMENT IS REQUIRED FOR OUR RECORDS.
If the beneficiary is a minor or incompetent, the person having custody of the beneficiary should complete the form and give his/her address in Item 8A. If you are signing as the guardian or
This completed form may be submitted by: UPLOAD:
Upload the form using our secure website at www.insurance.va.gov
MAIL:
VA Insurance Center
P.O. Box 7208
Philadelphia, PA 19101
5. FIRST, MIDDLE AND LAST NAME OF BENEFICIARY (Please print)
6. RELATIONSHIP TO INSURED
7. DATE OF BIRTH OF BENEFICIARY
8A. MAILING ADDRESS (MUST BE COMPLETED)
8B. BENEFICIARY'S SOCIAL SECURITY NUMBER
8C. EMAIL ADDRESS
8D. DAYTIME TELEPHONE NUMBER
IMPORTANT
CERTIFICATION: I certify that the above entries are true and correct to the best of my knowledge and belief.
9. SIGNATURE OF BENEFICIARY, FIDUCIARY OR GUARDIAN (Sign in ink)
10. DATE
COMPLETE THE BANK ACCOUNT INFORMATION BELOW IN BLOCKS A THROUGH E TO RECEIVE THIS PAYMENT ELECTRONICALLY. THE ACCOUNT MUST BE IN THE NAME OF THE PERSON, ESTATE, OR TRUST DESIGNATED AS BENEFICIARY OR FIDUCIARY. IF THE BENEFICIARY IS A TRUST OR ESTATE, YOU MUST COMPLETE BOX G.
A. NAME OF FINANCIAL INSTITUTION |
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B. ROUTING TRANSIT NUMBER (NINE DIGIT FIELD) |
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C. TELEPHONE NUMBER OF FINANCIAL INSTITUTION |
D. TYPE |
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E. DEPOSITOR ACCOUNT NUMBER |
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CHECKING |
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SAVINGS |
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F. BENEFICIARY'S SOCIAL SECURITY NUMBER (Required for Direct Deposit) |
G. EIN OR TIN NUMBER (FOR TRUST OR ESTATE ONLY) |
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PRIVACY ACT NOTICE: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses identified in the VA system of records, 36VA29, Veterans and Uniformed Services Personnel Programs of U.S. Government Life Insurance
RESPONDENT BURDEN: We need this information to determine, establish or verify your eligibility for VA Insurance benefits (38 U.S.C. 5902). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 6 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain. Comments on the accuracy of this burden or suggestions to decrease the burden may be included with the submission of this form or sent separately to VA Insurance Center, P.O. Box 7208, Philadelphia, PA 19101 or faxed to
IF YOU HAVE ANY QUESTIONS CONCERNING YOUR GOVERNMENT LIFE INSURANCE, PLEASE CALL OUR
VA FORM |
SUPERSEDES VA FORM |
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FEB 2020 |
WHICH WILL NOT BE USED. |