Get Bn 658 0212 Form

Filling out the Bn 658 0212 form online can be a straightforward process if you follow the necessary steps. This guide is designed to assist you in completing the form accurately and efficiently, ensuring that you submit a complete application for disability benefits.

Follow the steps to fill out the Bn 658 0212 form online.

1. Click the 'Get Form' button to obtain the Bn 658 0212 form and open it in your online editor.
2. Begin by completing the Employee’s Disability Benefits Application in full, which includes personal information such as your full name, social security number, and contact details.
3. Provide a detailed account of your condition, including the date the accident or illness began, previous related conditions, and the names and addresses of all treating physicians.
4. Complete the Attending Physician’s Statement section by having your physician share relevant medical information regarding your disability.
5. Ask your employer to fill out the Employer’s Report of Claim, ensuring to include employment status, salary information, and dates of last work.
6. Compile the completed documents: the Employee’s Disability Benefits Application, Employer’s Report of Claim, and Attending Physician’s Statement for submission.
7. Select your preferred method of benefits payment, such as direct deposit or debit card, by checking the appropriate box and providing necessary information.
8. Review all provided information for accuracy to avoid any delays in processing your claim.
9. Save your changes, then download, print, or share the completed form as necessary.

Take the first step towards your disability benefits by filling out your Bn 658 0212 form online today!