UUP Benefit Trust Fund Group Term Life Beneficiary Form

Please fill out the form below to electronically submit a Beneficiary form for your UUP Benefit Trust Fund Group Term Life Insurance.

To enroll and complete a paper enrollment form HERE and you may email, fax or mail to the UUP Benefit Trust Fund.

Fax: 1-866-559-0516 Mail: Benefit Trust Fund , PO Box 15143, Albany, NY 12212-9954 Email: Benefits@uupmail.org

Unum Life Insurance Company Group Policy

Number: 118668-36

Amount of Group Term Life Insurance: $6,000

Employee Information:

*First name:
Middle:
*Last name:
*Date of Birth:
NYS Employee ID:
*Address:
*City:
*State:
*Zip Code:
*Campus:
*Department:
*Non-SUNY Email:

*Required

Beneficiary Information:

First name:
Middle:
Last name:
Date of Birth:
Relationship:
Address:
City:
State:
Zip Code:

Add more beneficiaries:

(HERE)

*Acceptance of Terms

YES! I Agree that Submission of this form constitutes my consent to online beneficiary designation. You will receive an e-mail confirming receipt of this beneficiary form. Please retain a copy of that e-mail for your records.

* Required

United University Professions

UUP Benefit Trust Fund Group Term Life Beneficiary Form

Employee Information:

Beneficiary Information:

Beneficiary #2

Beneficiary #3

Beneficiary #4

*Acceptance of Terms

Not a UUP Member Yet?

Quick Links

United University Professions

UUP Benefit Trust Fund Group Term Life Beneficiary Form

Employee Information:

Beneficiary Information:

Beneficiary #2

Beneficiary #3

Beneficiary #4

*Acceptance of Terms

Not a UUP Member Yet?

Quick Links

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