Donate| Sign In|
The Pension Boards - United Church of Christ Inc
 Sign In
  • Home
    • About Us
    • Contact Us
  • Faith & Finance
  • Our Investments
  • Charitable Giving
  • Forms
  • News & Resources
  • Donate
  • Life & Disability
    • Basic Life Insurance
    • Optional Additional & Dependent Life Insurance
    • Disability Plan Facts
    • Life & Disability Publications
    • Life & Disability Forms

get adobe readerSome documents on this page may require the Adobe Reader.
You may download the Adobe Reader here.

Life & Disability Forms

Certification of Domestic Partner as Dependent or Non-Dependent

Domestic Partnership Statement of Financial Interdependence Form  

Life Insurance (LIDI) Designation of Beneficiary Form

Life Insurance and Disability Income (LIDI) Benefit Plan Enrollment Application

Life Insurance and Disability Income (LIDI) MetLife Enrollment Change Form

MetLife Privacy Notice

Optional Additional Death Benefit Application

Optional Additional Death Benefit Designation of Beneficiary Form

Optional Dependent Death Benefit Application

Statement of Dependent Eligibility Beyond Limiting Age in Plan Due to Mental Retardation, Mental or Physical Handicap 

Statement of Health Form

Toll-Free: 1.800.642.6543

Fax: 212.729.2701

Email: info@pbucc.org 

475 Riverside Drive

Room 1020

New York, NY 10115

MOST POPULAR

  • Rate Locator
  • Christmas Fund
  • UCC Medical Benefits Plan
  • Disability Plan Facts
  • Flexible Benefit Plan for UCC Ministries
  • Employee Pre-Tax Contributions
  • Non-Medicare Health Plan
  • Charitable Giving

ABOUT US

  • Board of Trustees
  • Executive Staff
  • Privacy Policies
  • Website Accessibility
  • Technology Resources
  • Career Opportunities
  • Contact Us
  • Internships

FOLLOW US

  • Facebook: 508237685873649
  • Twitter: PensionBoards
  • YouTube: PBUCC2010
Copyright©  The Pension Boards-United Church of Christ, Inc.
475 Riverside Drive, Room 1020, New York, NY 10115  •  Phone: 800.642.6543  •  Fax: 212.729.2701 •  E-mail: info@pbucc.org