|
To send a form to the Benefits office, use one of the following
addresses to mail it to your local office or directly to the
Vought Benefits Center, Dallas:
Dallas
Benefits M/S 49L-02
PO Box 655907
Dallas, TX 75265 |
Hawthorne
1 Northrop Avenue
Plant 3, M/S H1H/51
Hawthorne, CA 90250-3277
Attn: Ann Degennaro
|
Southeast
Sites
90 Highway 22 west
Milledgeville, GA 31061-9699
Attn: Patti Samprone
|
Benefits Forms
Select the appropriate File Type icon to
download the form.
- Microsoft Word Document
- Adobe Acrobat PDF file (The Acrobat
Reader is necessary for this format.)
Vought Employees Covered by a Collective Bargaining Agreement
|
Form #
|
Title
|
File Type
|
|
0-32406
|
Prudential POS Benefit Request Form
|
|
|
0-69170
|
Address Authorization
|
|
|
1-19672
|
Flexible Spending Account Request For Disbursement
Health Care and Dependent/Child Care Expenses
|
|
|
H0-F065
|
Beneficiary Designation For Life and Accidental Insurance
|
|
|
H0-F067
|
Certification of Eligible Step-Children
|
|
|
H0-F068
|
Student Status Verification
|
|
|
H0-F069
|
Disabled Dependent Certification
|
|
|
H0-F070
|
Add/Change Form (UAW)
|
|
|
H0-F071
|
IBEW/SPFPA Add/Change Form
|
|
|
H0-F073
|
POS/HMO Enrollment/Change
|
|
|
H0-F079
|
Notice of Group Life Conversion Privilege
|
|
|
H0-F081
|
Attending Dentist's Statement
|
|
|
GL.98.517-G
|
Prudential Insurance - Evidence of Insurability
|
|
|
SOH2000
|
MetLife Long-Term Disability Evidence of Insurability
|
|
|
 |
