Follow the steps to fill out the Eip Universal Name Change Form online.

1. Press the ‘Get Form’ button to access the form and open it in your browser.
2. Select the type of subscriber by checking the appropriate box: 'Active', 'Retired', 'COBRA', or 'Survivor'.
3. Fill in the PEBA Insurance Benefits Group Number. This is a required field to identify your benefits package.
4. Indicate the type of change you are making by checking all boxes that apply: 'Name', 'Marriage', 'Divorce', or 'Address'.
5. Provide your Social Security number or Benefits Identification number in the specified fields.
6. Input your new name in the designated sections, ensuring to include your first, middle initial, and last name.
7. Enter your street address, including any apartment number, in the appropriate fields.
8. Complete your city, state, and ZIP code details accurately.
9. Fill in your home and work phone numbers, including the area code.
10. Provide your email address to ensure communication regarding your name change.
11. If applicable, enter your previous name and previous address as requested.
12. Sign and date the form as the subscriber. If required, ensure the benefits administrator also signs and dates the form.
13. Once all sections are complete, save changes to the form, and download, print, or share as needed.

Complete your Eip Universal Name Change Form online to ensure a smooth transition for your name or address change.