You may fill in and/or print any of the forms below for your use and distribution. You will need Adobe Acrobat Reader in order to view, fill in and print these forms.  You may contact the VEBA third-party administrator for a supply of forms and/or contact your benefits department.

VEBA Plan Membership Enrollment Kit Description of Plan Benefits & Membership Enrollment Form (PDF) Investment Fund Information (PDF) Claim Form for Medical/Dental/ Vision Expenses or Premiums (PDF)  Systematic Payment Form (PDF)      Account Information / Fund Allocation Change Form  (PDF) Direct Deposit Enrollment Form-- if you want to make direct deposit effective on your account, please complete this form and mail or fax to the Plan Administrator's office listed on the form.(PDF) E-statement Sign Up Form--complete this form if you want to receive your periodic participant activity statements via e-mail. (PDF)                 You must have Adobe Acrobat Reader installed on your system to read the PDF files above.