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E Goodyear Tire and Rubber Company Report Number 96313, 96314 Sub Code Branch SECTION 2: Your Enrollment Information (To be completed by the Employee) First Name Middle Name Address (Street) Last Name State City ZIP Code Date of Birth (mm/dd/yyyy) Social Security Number Email Address New Enrollment Change in Enrollment If due to a Qualifying Event, enter event date (mm/dd/yyyy) Male Female Phone Number I have read my enrollment materials and I request coverage for the benefits f.

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How to fill out the MetLife GTRC-SALARIED online

This guide provides user-friendly instructions for completing the MetLife GTRC-SALARIED form online. Follow these steps carefully to ensure your enrollment or changes to your coverage are processed smoothly.

Follow the steps to fill out the MetLife GTRC-SALARIED form accurately.

  1. Click ‘Get Form’ button to obtain the MetLife GTRC-SALARIED form and open it in your browser.
  2. In Section 1, provide the group customer information, including the Name of Group Customer, Group Customer Number, Report Number, and Sub Code as required.
  3. Move to Section 2 where you will input your enrollment information. Fill in your first name, middle name, last name, address (street), city, state, and ZIP code. Enter your date of birth and social security number, along with your email address and phone number.
  4. Indicate whether this is a new enrollment or a change in enrollment. If the change is due to a qualifying event, enter the event date.
  5. Select your gender and acknowledge that you have read the enrollment materials. Choose the type of coverage you are requesting, including Group Universal Life Insurance and Dependent Spouse/Domestic Partner coverage, marking the applicable options.
  6. If you are applying for dependent coverage, provide the necessary information in the Dependent Information section, including first names, middle names, last names, dates of birth, and gender for each dependent.
  7. Complete the Smoking Status Information by indicating your smoking status for yourself and any dependents as necessary.
  8. Review the Fraud Warnings in Section 3 and understand the legal implications of providing false information.
  9. In Section 4, designate primary and contingent beneficiaries by filling out their names, relationships, and addresses.
  10. In Section 5, read the Declarations and Signature statements carefully. Sign your name and date it to confirm all information is accurate.
  11. Finally, in Section 6, review the instructions for submission. Make sure to print a copy for your records and mail the original form to the address provided.

Complete your enrollment by filling out the MetLife GTRC-SALARIED form online today!

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How do I upload documents to MetLife? Visit mybenefits.metlife.com or download the MetLife Mobile App to view your certificate of insurance and to initiate your claim* or call 866-626-3705 to obtain a claim form*. Answer some questions about your claim and upload your medical documentation to support your claim.

Online. If you're an individual beneficiary: complete online. If you're a trust or entity: complete online. Email to INDlifeclaims@metlife.com. Fax to 1-908-655-9586. Mail via USPS to the address provided on your claim kit.

How to submit a claim: Sign in to MyBenefits now. Make sure to have the following information available: Your contact information. Disability details. Physician contact information. A MetLife Claims specialist will be in touch within 1-2 business days to confirm next steps.

Term Life, Whole Life, and Universal Life Policies. Variable Life Policies. MetLife. PO Box 371351. Pittsburgh, PA 15250-7351. For all other policies: MetLife. PO Box 371487. Pittsburgh, PA 15250-7487.

your information on file, you'll need to include documentation to support your authority to request the change. Please complete, sign and return this form with a copy of the required document(s) or your request may be delayed. You can reach us at 1-800-638-2704, Monday through Friday, 8 a.m. to 9 p.m. Eastern Time.

To request a new form call 800-638-7283 to request a new form or you may download one by logging onto .metlife.com. Please make a copy of the completed form for your records. Specific individuals must be named as beneficiaries (e.g., the term “Grandchildren” is not acceptable).

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