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Get Dfas Annuitant Certificate Of Eligibility Form

CERTIFICATE OF ELIGIBILITY MBR SSN ANNT A Certificate of Eligibility COE is required annually from each annuitant. To prevent a delay in receiving your annuity payments please COMPLETE SIGN and RETURN this COE immediately to DFAS Retired and Annuitant Pay PO Box 7131- Annuitant Pay London KY 40742-7131. CERTIFICATE OF ELIGIBILITY MBR SSN ANNT A Certificate of Eligibility COE is required annually from each annuitant. To prevent a delay in receiving your annuity payments please COMPLETE SIGN and RETURN this COE immediately to DFAS Retired and Annuitant Pay PO Box 7131- Annuitant Pay London KY 40742-7131. If you have any questions call toll-free at 1-800-321-1080 or use our toll free FAX 1-800-982-8459. Your marital status is required to update your account. Please place an X in the applicable box I did not marry in the past year. I married in the past year please attach a copy of your marriage certificate. I certify that I am the annuitant or the annuitant s legal representative custodian trustee guardian legal fiduciary or power of attorney and the information given is correct. I will promptly notify DFAS at the above address if any change occurs in my the annuitant s marital status or if I the legal representative have knowledge the annuitant is deceased* If this COE is signed by a legal representative for the first time a photocopy of the legal document must be attached* Signature Date Please check the appropriate boxes below. IF YOU ARE THE ANNUITANT COMPLETING THIS FORM DO NOT CHECK THIS BOX I am the legal representative for the annuitant My the annuitant s address has changed New Street Address City State Zip Code NOTE Penalty for presenting false claims or making false statements in connection with claims Fine of not more than 10 000 on imprisonment for not more that 5 years or both 18 USC 1001. PRIVACY ACT STATEMENT AUTHORITY 37 USC Chapter 11 EO 9397 Nov 1943. PRINCIPAL PURPOSE This information is used to determine the continued eligibility of the annuitant for annuity payments. ROUTINE USES Records from this system of records may be disclosed to the Department of Veterans Affairs VA. DISCLOSURE Disclosure is voluntary however failure to provide information will result in suspension of annuity payments. To prevent a delay in receiving your annuity payments please COMPLETE SIGN and RETURN this COE immediately to DFAS Retired and Annuitant Pay PO Box 7131- Annuitant Pay London KY 40742-7131. If you have any questions call toll-free at 1-800-321-1080 or use our toll free FAX 1-800-982-8459. If you have any questions call toll-free at 1-800-321-1080 or use our toll free FAX 1-800-982-8459. Your marital status is required to update your account. Please place an X in the applicable box I did not marry in the past year. Your marital status is required to update your account. Please place an X in the applicable box I did not marry in the past year. I married in the past year please attach a copy of your marriage certificate. I certify that I am the annuitant or the annuitant s legal representative custodian trustee guardian legal fiduciary or power of attorney and the information given is correct.

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