Get Form Rm05 Request For American Income Medical/a D & D Coverage - Purdue

Filling out the Form RM05 is essential for obtaining American Income Medical/A D & D coverage through Purdue. This guide will provide you with structured steps to accurately complete the form online.

Follow the steps to fill out the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the date of request section, enter the date you are submitting the form. Use the format MM/DD/YYYY.
3. Complete the requested by section with your name, phone number, and department name to identify who is making the request.
4. For the activity section, provide the name, description, and acronym (if applicable) of the activity that requires coverage.
5. In the location of activity field, specify where the event will take place.
6. Fill out the coverage begin and end dates to indicate the timeframe for which coverage is needed.
7. Estimate the number of participants who will be involved in the activity and enter that number in the designated field.
8. Complete the fund and cost center section to indicate where charges for this coverage should be applied.
9. Once all fields are completed, review your entries for accuracy.
10. After verifying the information, save your changes, download the form, print it, or share as necessary.

Complete your documents online today for efficient processing.