INSTRUCTIONS FOR COMPLETING FORMER PARTICIPANT CLAIM FORM Sample Clauses

INSTRUCTIONS FOR COMPLETING FORMER PARTICIPANT CLAIM FORM. 1. Complete this claim form and keep a copy of all pages of your Former Participant Claim Form, including page 1 with the address label, for your records.
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INSTRUCTIONS FOR COMPLETING FORMER PARTICIPANT CLAIM FORM. 1. If you would like to receive your settlement payment, please complete this claim form. You should also keep a copy of all pages of your Former Participant Claim Form, including the first page with the address label, for your records.

Related to INSTRUCTIONS FOR COMPLETING FORMER PARTICIPANT CLAIM FORM

  • Claim Form i. Within 15 days after receiving a notice of a claim, you or your Dental Provider will be provided with a Claim Form to make claim for Benefits. To make a claim, the form should be completed and signed by the Provider who performed the services, and by the patient (or the parent or guardian if the patient is a minor), and submitted to the address above.

  • Procedure for Benefits Modifications 1. Proposals for major retirement benefit modifications will be negotiated in joint meetings with the certified employee organizations whose memberships will be directly affected. Agreements reached between Management and organizations whereby a majority of the members in LACERS are affected shall be recommended to the City Council by the CAO as affecting the membership of all employees in LACERS. Such modifications need not be included in the MOU in order to be considered appropriately negotiated.

  • Claims Procedure An Executive or Beneficiary (“claimant”) who has not received benefits under this Agreement that he or she believes should be distributed shall make a claim for such benefits as follows:

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