Get Work Release Insurance Form 2011-12 - Chfs Ky

Filling out the Work Release Insurance Form 2011-12 - Chfs Ky online is a straightforward process that ensures your coverage under the Kentucky Volunteer Insurance Program. This guide will help you navigate each section of the form with clarity and ease.

Follow the steps to successfully complete the Work Release Insurance Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your personal information. In the NAME field, provide your last name, first name, and middle initial. Ensure accuracy for identification purposes.
3. Next, fill in your PHONE NUMBER, making sure to include the area code. This is critical for contact purposes.
4. Enter your DATE OF BIRTH in the dd/mm/yyyy format. This information helps in verifying your age eligibility.
5. Provide your SOCIAL SECURITY NUMBER. This is necessary for proper identification and to secure your insurance coverage.
6. Input your ADDRESS, including street, city, and zip code. This ensures that any relevant correspondence can reach you.
7. Describe your VOLUNTEER ACTIVITY in the provided section. This information is essential for understanding the context of your coverage.
8. Have your SUPERVISOR sign for verification of your volunteered activity. Include their TITLE and PHONE NUMBER for any follow-up.
9. Fill in the BENEFICIARY OF THE INSURED section, including their NAME, ADDRESS, SOCIAL SECURITY NUMBER, and PHONE NUMBER.
10. Review the fee information. Ensure you include PAYMENT for the insurance rate of $64.00 and a $7.00 handling fee in the TOTAL AMOUNT ENCLOSED: $71.00.
11. Check that you have signed the form before submission. Your signature is necessary to confirm all details provided.
12. After completing all sections, save your changes. You can download, print, or share the completed form as needed.

Complete your Work Release Insurance Form online today to secure your coverage and ensure a smooth process.