Get State Form 10564 (r5 / 12-11)

Completing the State Form 10564 (R5 / 12-11) online can streamline your application process for disability benefits. This guide provides detailed instructions tailored to help you navigate each section of the form with ease.

Follow the steps to complete your application successfully.

1. Click ‘Get Form’ button to access the application form and open it in the online editor.
2. Begin by entering your personal information in the Member Information section. Include your full name, Social Security number, marital status, address, date of birth, municipality where you are employed, and your telephone number.
3. Next, indicate the type of disability you are applying for by checking the appropriate box, and provide the source of your income along with your Pension ID number.
4. If applicable, fill in the Spouse Information section with your spouse's Social Security number, name, and date of birth.
5. Review the Member Affidavit section carefully. You must confirm that the information you provided is true and complete. You will need to provide your signature and the date.
6. Complete the Employer Certification section, if required. This may involve your employer certifying your membership and employment status in the pension fund.
7. Fill in the Last Day in Pay Status section by providing the last day you received full pay from your employer. Make sure to include the date of your last check, if known.
8. At the end of the form, ensure that you fill in any additional information requested. Once completed, save your changes, download the form, print it, or share it as needed.

Take the step towards securing your benefits by completing your State Form 10564 (R5 / 12-11) online today.