Get Facility Of Payment Affidavit - Wordpress.com

Filling out the Facility Of Payment Affidavit correctly is essential for ensuring that the correct beneficiaries are identified. This guide will provide you with clear, step-by-step instructions on how to effectively complete the affidavit online.

Follow the steps to successfully complete the affidavit.

1. Click the ‘Get Form’ button to access the affidavit and open it in the online editor.
2. Begin by filling out the employee's name and claim number at the top of the form. Ensure that this information is accurate to avoid any delays.
3. Section A asks about the employee's estate. Indicate whether an estate has been established by selecting 'Yes' or 'No.' If 'Yes', provide the name of the executor and the tax identification number. If 'No', indicate whether an estate will be established.
4. In Section B, provide information regarding the employee’s spouse, civil union partner, or domestic partner if applicable. Select the correct option and include their name, address, Social Security number, and date of birth.
5. Move to Section C, which requires information about all natural and legally adopted children. Fill in their names, addresses, Social Security numbers, and dates of birth. If there are more than four children, provide the extra details on a separate sheet.
6. Continue to Section D, where you will enter details about the employee’s parents. Include the names, addresses, Social Security numbers, and dates of birth. If both parents are deceased, skip to Section E.
7. In Section E, provide information for all siblings. Similar to Section C, include their names, addresses, Social Security numbers, and dates of birth. Again, if there are more than three siblings, use a separate sheet.
8. In Section F, the person completing the form must sign and date it, confirming that the information provided is accurate. This section also requires the printed name, date of birth, complete address, relationship to the insured, and telephone number.
9. Finally, Section G needs to be completed by a notary. The notary will sign, provide the date, and indicate the expiration of their commission.
10. Once all sections are filled out and verified, save your changes. You may choose to download, print, or share the completed affidavit as needed.

Complete your affidavit online today to ensure your information is processed accurately.