Get Affidavit Of Child Dependency - Phillips 66

Filling out the Affidavit Of Child Dependency for the Phillips 66 Medical and Dental Assistance Plan is a crucial step in ensuring eligibility for benefits. This guide will outline clear instructions to assist you in completing the form accurately and efficiently online.

Follow the steps to fill out the affidavit accurately

1. Click ‘Get Form’ button to access the Affidavit Of Child Dependency and open it in your preferred online document editor.
2. In the first field, enter the name of the Employee or Retiree who is filling out the form. Ensure to print the name clearly for legibility.
3. Next, provide the Employee ID number in the designated field. This identifier is essential for processing your affidavit.
4. List the names of the children for whom you are claiming dependency in the respective fields labeled 'Child Name.' Ensure each name is accurately spelled.
5. Review the eligibility criteria for each child listed. Confirm that each child meets the outlined requirements regarding age, support, and living situation.
6. Sign the affidavit in the designated area to affirm your financial support for the listed children. Date the document accordingly.
7. If required, have the document notarized by a certified Notary Public to validate the affidavit.
8. Once all fields are filled out, save any changes made to the document. You can choose to download, print, or share the completed form as needed.

Complete the Affidavit Of Child Dependency online to ensure your child's eligibility for benefits today.