Get Statement Of Facts - Culinary Health Fund - Culinaryhealthfund

Completing the STATEMENT OF FACTS form for Culinary Health Fund is an important step in requesting benefits due to injuries. This guide provides a detailed walkthrough on filling out the form accurately and efficiently, ensuring that all necessary information is provided.

Follow the steps to effectively submit your statement of facts.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Enter the participant name in the designated field. This should be the name of the person requesting benefits.
3. Provide the spouse name in the next field, if applicable. If there is no spouse, this field may be left blank.
4. Input the social security number of the participant. This is crucial for processing your request.
5. Fill in the spouse's social security number, if applicable.
6. Specify the residential address, including number, street, city, state, and zip code.
7. In the section that follows, complete your name again, along with your address details.
8. Indicate the date when the injury occurred.
9. Answer the questions in the provided section, detailing the type of accident and injuries sustained.
10. If any covered dependents were involved in the accident, list their names in the appropriate section.
11. Provide the name, address, phone number, and insurance information of the responsible party, if known.
12. If you have legal representation, fill out your attorney’s name, address, and phone number.
13. Select one of the options regarding your claim intentions. It is essential to check only one box.
14. Finally, sign the form as the injured party and, if necessary, include the signature of a parent or guardian if the injured party is a minor.
15. Save your changes, download or print the form as needed, or share it to complete your submission.

Start completing your STATEMENT OF FACTS form online now to ensure a smooth claims process.