Follow the steps to successfully complete your claim form.

1. Click ‘Get Form’ button to obtain the form and open it in an editor.
2. Begin by entering the patient’s name in the designated field. It is crucial that this matches the name on your medical receipts.
3. In the section labeled 'Relationship to Member,' select the appropriate option that describes your relationship to the patient: self, spouse, child, or other.
4. Complete the fields for the name of the member, their Social Security number, and their home address, including city, state, and zip code.
5. Fill in the patient's birthday and the date of employment in the Yonkers system. This information helps verify eligibility.
6. Answer the questions about whether optical benefits are available from another Yonkers Federation of Teachers member or from any other provider. If yes, please provide additional information.
7. Indicate if any vision charges relate to a sickness or accident due to occupation or if treatment was required because of accidental injury. If yes, attach an explanation of the circumstances.
8. Select the services performed by checking the relevant boxes for eye examination, lenses, or frames.
9. Enter the total amount claimed in the designated space. Ensure that the amount aligns with the receipts provided.
10. Read the certification statement and sign where indicated, along with the date. This serves to confirm the accuracy of the information provided.
11. To complete the process, save your changes, and choose to download, print, or share the completed form as needed.

Start filling out your Yft Welfare Fund form online today to claim your benefits.