Get Management Benefits Fund (mbf) Health Club Reimbursement Program Claim Form - Please Print - I - Nyc

Filling out the Management Benefits Fund (MBF) Health Club Reimbursement Program Claim Form can be straightforward if you follow the right steps. This guide is designed to help users navigate each section of the form with clarity and ease, ensuring a smooth reimbursement process.

Follow the steps to successfully complete your claim form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by checking one of the options for the claimant type in Section I. Indicate whether you are claiming as an MBF member or as the spouse/domestic partner of the MBF member.
3. In Section II, fill out your MBF member information. Include the social security number, agency name, last name, first name, middle initial, address, city, state, ZIP code, work telephone number, and home telephone number.
4. If you are the spouse or domestic partner of the MBF member, complete Section III with your last name, first name, and middle initial.
5. Proceed to Section IV to provide direct deposit information if applicable. For this, include the ABA number, account type (checking or savings), and the names of persons on the account. Ensure the account number is included correctly.
6. In Section V, indicate the claim period by filling out the start and end dates. Remember that the end date must not exceed two years from the date of claim submission.
7. Sign and date the form in Section VI, acknowledging the terms stated. Ensure that if you are claiming as a spouse or domestic partner, your signature is also included here.
8. Move to Section VII to provide details about the health club fitness facility. Fill out the facility name, manager's name, address, city, state, ZIP code, federal tax ID number, membership purchase date, and type of membership.
9. Section VIII requires the facility manager’s signature to validate your attendance. Make sure they complete this section and provide the date.
10. Double-check all the filled sections for accuracy and completeness to avoid delays in processing your claim.
11. Upon ensuring all details are correct, save changes, download, print, or share the completed form as needed for submission.

Complete your claim form online today to take advantage of the benefits through the MBF Health Club Reimbursement Program.