Metlife eforms.

Welcome to MetLife's eForms! As of December 8, 2023, forms will be accessed as follows: MetLife Associates will be redirected to a new site that will require log in with existing SSO credentials. MetLife Customers will still be able to obtain forms through MetOnline by accessing www.metlife.com. JY1178-1 (06/22) Page 3 of 3 Fs/f 4. First name Middle name Last name Address City State ZIP Date of birth (mm/dd/yyyy) Phone number Year of death (if applicable) Social Security (if available) Note: If additional space is needed, please use an additional plain sheet of paper. About the Deceased's estate • Has a court issued, or is it expected to issue, a document appointing an executor or ...Please Wait.....detail the rights and obligations of both You and MetLife with respect to the coverage. It is, therefore, important that You READ YOUR CERTIFICATE CAREFULLY! (3) Critical Illness coverage is designed to provide, to persons insured, restricted coverage paying benefits as a lump sum ONLY when certain losses occur as a result of certain specifiedMetLife US Mobile app is now available to Download it on the iTunes App Store use to track the status of your disability claim. and Google Pl1 ay. Mail MetLife Disability / P.O. Box 14592 / Lexington, KY / 40512- -4592 8. Who can I contact for assistance? MetLife - Customer Service Center - 1-866-729-9201

The Full Repository Name/Number Search searches the entire eForms repository and may return a large number of forms. Please use this search only if you know what you are looking for. ... Recordkeeoina customeß MetLife Insurance Comoam¿ NS Recordkeeoinll O Box 14401 Lexinatom KY 40512-4401) Benefit Decisions As You Leave the Comoanv FDIC FormDental policy waived if you provide proof of current coverage. Please contact MetLife at 1-844-2METDEN. By applying for this insurance coverage, do you intend to lapse or otherwise terminate any existing dental insurance currently held by you? Yes No. Dental Insurance First select your option Then select your level of coverage. High Plan Self Only

MetLife family of companies. The Trustee (s) should complete and execute this form. NOTE: For Tax Qualified Retirement Plans purchasing Metropolitan Life Insurance Company or Metropolitan Tower Life Insurance Company life insurance, follow the new business procedures for selling life insurance in a Qualified Plan, not this Trust Certification form.MetLife Attn: Administration P.O. Box 14593 Lexington, KY 40512-4593 Fax: 1-888-505-7446 *Dental HMO plans in CA, FL and TX are available through a domestic company in the applicable state named SafeGuard Health Plans, Inc. The SafeGuard companies are part of the MetLife family of companies.

contract holder or benefit plan administrator to disclose to MetLife, and any consumer reporting agencies, investigative agencies, attorneys, and independent claim administrators acting on MetLife’s behalf, any and all information about my health, medical care, employment, and my claim for disability benefits and/or my Leave Request.Meghan Lantier. 980-949-4142. [email protected]. For Investors: John Hall. (212) 578-7888. MetLife. Today, MetLife, Inc. announced it will rebrand its U.S. Retail business as Brighthouse Financial after it is separated from the company.during a shorter time period. MetLife’s one-year term products are designed to deliver the right amount of affordable protection when it’s needed most. MetLife’s one-year term products are simple, straightforward term life insurance policies. You choose the death benefit, and once approved, you are protected for one year.1 . For youMetLife Attn: Administration P.O. Box 14593 Lexington, KY 40512-4593 Fax: 1-888-505-7446 *Dental HMO plans in CA, FL and TX are available through a domestic company in the applicable state named SafeGuard Health Plans, Inc. The SafeGuard companies are part of the MetLife family of companies.

protection, MetLife requires that you submit a timely and complete certification based on your leave reason. • Remember to add your First and Last Name along with the claim form number to all pages so that we can match this certification with your absence request. Reminder: Forms marked as lifetime, unknown, as needed, indeterminate or

MetLife Disability 1-800-230-9531 PO Box 14590 Lexington KY 40512-4590 DIS-HCPC-FMLA-FMHC (06/20) Page 4 of 4. Created Date: 20200630065520Z ...

To complete and e-sign your documents we must first verify your identity. Please provide the information requested below, all required fields must be completed in order to proceedPage 1 of 4 PARTIALWITHDRAWAL (01/22) Fs/f. Partial Cash Withdrawal Request . Use this form to request a partial cash withdrawal from a Universal Life or VariableMetLife shall be entitled to rely upon all banking/depository information (bank name, account number, etc.) on this form and the voided check (if attached). MetLife shall not be required to verify the accuracy of any bank/depository information (including but not limited to the name on the bank/depository account) and may rely solely on the bank/Please Wait.....MetLife Annuity Operations 4700 Westown Pkwy, Ste 200 West Des Moines, IA 50266 Fax: 877-547-9669. Email: [email protected]. Created Date: 11/23/2016 3:52:33 PM ...MetLife Disability 1-800-230-9531 PO Box 14590 Lexington KY 40512-4590 DIS-HCPC-FMLA-CSM (06/20) Page 4 of 4. Created Date: 20200630071926Z ...MetLife P.O. Box 10342 Des Moines, IA 50306-0342 Express Mail Only: MetLife 4700 Westown Parkway, Suite 200 West Des Moines, IA 50266 Fax: 877-547-9669 Email: [email protected] ANN-BENE (06/22) Page 5 of 6

MetLife Group Life Claims P.O. Box 6100 Scranton, PA 18505-6100 Email: [email protected] Fax: 1-570-558-8645 If faxing, please remember to fax both front and back sides of the signed claim form. Allow two (2) hours for documents to be received. If emailing, please be advised: Accepted document types: Word Document, PDF and JPEG.Please Wait.....8. Please fax completed form to: 866-314-5595 or Email: [email protected]. 9. Questions? Please email your questions to Email: [email protected] Requesting Agency Name: Agency #: Distribution: Insured's Name: Policy No.: Policy State: New Servicing Agent Name: Agent No.: SSN: New Servicing Agent Correspondence Address:detail the rights and obligations of both You and MetLife with respect to the coverage. It is, therefore, important that You READ YOUR CERTIFICATE CAREFULLY! (3) Critical Illness coverage is designed to provide, to persons insured, restricted coverage paying benefits as a lump sum ONLY when certain losses occur as a result of certain specifiedPlease Wait.....Find and download the form you need for your MetLife insurance, annuity, or retirement plan. Access eForms for various products and services online.

I/We may revoke this authorization only by notifying MetLife in writing. Signature of Contract Owner Date (mm/dd/yyyy) Signature of Contract Joint Owner (if applicable) Date (mm/dd/yyyy) SECTION 4: How to submit this form Please send us the entire form by mail or fax. Regular Mail: MetLife P.O. Box 10342 Des Moines, IA 50306-0342 Overnight mail ...

Please Wait..... ReadyPlease read this disclosure form so you are provided with a balanced explanation of the MetLife Financial Freedom Select e-Bonus Class 403 (b) variable annuity (or "MFFS ® e-Bonus"). It is important to MetLife that you understand all of your choices and options and make an informed decision. This disclosure form should beजनसुनवाई -समाधान एंड्रॉइड एप्लिकेशन मोबाइल गवर्नेंस के दृष्टिगत जनसुनवाई एंड्राइड मोबाइल ऐप का निर्माण किया गया है icontract into an existing MetLife non-qualified annuity contract in a full or partial 1035 exchange your MetLife non-qualified annuity contract's after-tax basis and tax-deferred gain will be adjusted to include the basis and gain transferred from the exchanged contract. Therefore, because partial withdrawals fromProspectuses for variable products issued by a MetLife insurance company, and for the investment portfolios offered thereunder, are available from your financial professional. The contract prospectus contains information about the contract's features, risks, charges and expenses. Investors should consider the investment objectives, risks ...• Documentation that might be helpful to MetLife in making a claim decision includes the following items: Itemized invoices received for services as a result of this accident. You may need to ask your healthcare provider to provide you with a UB-04 form or other documentation. If you have an Explanation of Benefits (EOB), Contact us by phone 1-800-638-7283 or email at [email protected] and include your name and account number in the email Monday through Friday 8:00 a.m. through 6:00 p.m Eastern Time.Return this form to MetLife by: Mail: Metropolitan Life Processing Center. P.O. Box 3867. Scranton, PA 18505-0867. Fax: 866-347-4483. Email: [email protected]. We're here to help. Please don't hesitate to contact us if you have any questions. You can reach usUnder this authorization, I understand that MetLife will initiate monthly debit entries to my Account for the premium payment due for my Long-Term Care Insurance Coverage in effect for that month. Debits to the Account will occur on the date designated below or the next business day. I authorize the Financial Institution toProspectuses for variable products issued by a MetLife insurance company, and for the investment portfolios offered thereunder, are available from your financial professional. The contract prospectus contains information about the contract's features, risks, charges and expenses. Investors should consider the investment objectives, risks ...

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DINFO / 04-16 PAGE 1 SafeGuard Health Plans, Inc. SafeHealth Life Insurance Company DENTAL PROVIDER RE-CREDENTIALING APPLICATION The participating provider must complete the entire application.

Return this form to MetLife by: Mail: Metropolitan Tower Life Insurance Company P.O. Box 80826 Lincoln, NE 68501-0826. Fax: 1-855-306-7350 Email: [email protected] Insurance Company (collectively, “MetLife”). Please read it carefully. You have received this notice because of your Dental, Vision, Long-Term Care, Cancer and Specified Disease Expense Insurance, or Health coverage with us (your “Coverage”). MetLife strongly believes in protecting the confidentiality and security of information wePage 1 of 4 PARTIALWITHDRAWAL (01/22) Fs/f. Partial Cash Withdrawal Request . Use this form to request a partial cash withdrawal from a Universal Life or VariableFor questions, call MetLife at 1-800-638-6420, prompt 1 (Statement of Health Unit) or email us at [email protected]. Metropolitan Life Insurance Company, P.O. Box 14593 Lexington, KY 40512-4593 FAX: 1-888-505-7446 Note: Additional medical information may be required after MetLife's initial review of a completed Statement of Health form.Your WBC level of 13.3 is a High WBC level. High levels of WBC in the blood indicate a variety of health problems. If your blood WBC level is between 4 thou/uL and 11 thou/uL, you probably do not have an underlying health problem. But if WBC levels are not in this range, you should see a doctor immediately.Go to metlife.com/lifeclaims to 1 login or set up an account. Enter the following codes: 2 Identity: ________________ Access: ________________. 3 Upload pictures of supporting documents. Live agents are just a phone call away if you need help. Access it all online.This operation is blocked due to security issue.Please visit home page and then navigate to respective pages.I agree to repay to MetLife any and such amount. 2. If for any reason I fail to repay MetLife in accordance with paragraph 1, above, I agree that MetLife may reduce my monthly benefit below the Minimum Monthly Benefit as stated in the Schedule of Benefits, until such time as MetLife has recovered the full amount of the overpayment .

health, medical care, employment, and claim for disability benefits or Leave Request. I also permit MetLife to contact any health care provider who has submitted a medical certification to MetLife in connection with my Leave Request in order to authenticate, clarify, or obtain any information missing from the certification.each page, to MetLife Disability by: Mail: Fax: MetLife Disability 1-800-230-9531 PO Box 14590 Lexington KY 40512-4590 APS-STD-LTD-5320 (01/23) Page 5 of 7. Disability Claims Fraud Warnings Before signing this claim form, please read the warning for the state where you reside and for the state whereOwner initial here. Date (mm/dd/yyyy) Page 5 of 11 RIS-SBR-BENECHANGE (11/22) Fs/f Option C - Living (Inter vivos) Trust described below. I choose the trust identified below as my Contingent Beneficiary. Name of Trust Date of Trust (mm/dd/yyyy) State where Trust was created Trust address - Street City State ZIPTo complete and e-sign your documents we must first verify your identity. Please provide the information requested below, all required fields must be completed in order to proceed Instagram:https://instagram. petland in san antoniowww.myaarpmedicare.com registernick jr crocodilesreal mr hands video MetLife P.O. Box 10342 Des Moines, IA 50306-0342 Overnight Mail Only: MetLife 4700 Westown Pkwy, Ste 200 West Des Moines, IA 50266 . Fax: 877-547-9669 Mailing Instructions. Signature Joint-Owner's Signature. Irrevocable Beneficiary's Signature(s) Irrevocable Beneficiary's Signature(s) Date Date broome county humane society photosdraft simulator with trades Send the completed form to the MetLife Record Keeping Center, P.O. Box 14401, Lexington, KY 40512-4401. If you wish to name more beneficiaries than this form provides for, secure an additional copy. Complete your list of beneficiaries on that form. Attach the additional form to the first, indicating clearly on each form thePage 1 of 5 DIVRIDWITHDRAWAL (01/22) Fs/f U.S. Retail Life Operations. Dividend/Rider Withdrawal and Dividend Option Change Request . Use this form to request a dividend withdrawal or a withdrawal from a rider on your policy edd card login my estate shall be full discharge of the liability of MetLife under the Group Policy. SECTION 6: Signature Insured Name (please print) Daytime Phone Number Address City State ZIP Insured Signature Date Signed (mm/dd/yyyy) SECTION 7: How to Submit This Form Mail: MetLife Disability PO Box 14590 Lexington KY 40512-4590 Fax: 1-800-230-9531PDF version (340 KB) Request a Loan Form. This form is used to request a loan on your life insurance policy. PDF version (250 KB) Partial Withdrawal Form. This form is used to request a partial withdrawal from a universal life policy. PDF version (246 KB) Dividend Withdrawal Form.8. Please fax completed form to: 866-314-5595 or Email: [email protected]. 9. Questions? Please email your questions to Email: [email protected] Requesting Agency Name: Agency #: Distribution: Insured's Name: Policy No.: Policy State: New Servicing Agent Name: Agent No.: SSN: New Servicing Agent Correspondence Address: