Request form

Physician Certificate for Child Annuitant

Request form

OMB: 0730-0011

Document [doc]
Download: doc | pdf


     

Month XX, 20XX

     

     

     

     



Dear      :


This correspondence is in reference to your recent request. We need additional information before we can update your account. Please provide the information on the enclosed form and return it in the envelope we have provided.


Full first name, middle initial and last name: Box    


Social Security Number (SSN) of the annuitant: Box     


Social Security Number (SSN) of the retiree: Box     


The following supporting document(s):      .


Complete, sign and return enclosed form(s).


Signature required.


Other:      .


If you have any further questions, you can contact one of our customer care representatives at 800‑321‑1080 or 216-522-5955, between 8:00 a.m. and 5:00 p.m., Eastern Standard Time, Monday through Friday, or write to us at the address above.


Sincerely,





     

Retired and Annuitant Pay


Enclosures:

As stated

File Typeapplication/msword
File TitlePay Verification (ANN)
AuthorNTUSER
Last Modified ByDaniel Urchick
File Modified2017-03-29
File Created2017-03-29

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