Benefit Forms

Below is a listing of benefit and retirement forms.  

Web site has been changed. All forms can now be found at: http://www.uri.edu/human_resources/forms.html

Application for Health  / Change in Status form

Common Law Affidavit

Domestic Partner Affidavit

Domestic Partner Dependency Affidavit

ERSRI Beneficiary Form

Legal Authorization Form

Life Insurance Add/Cancel/Waive Form

Life Insurance Beneficiary Form (PDF)

Long Term Disability Prior Employer Coverage

PF-14  (open or change your 403(b) retirement annuity contribution percentage)

PF-15 (open a Supplemental Retirement Account)

PF-16 (change your Supplemental Retirement contribution percentage, or change your carrier)

Savings Bond application (this is a PDF file)

Student Affidavit for Health Coverage

TIAA Beneficiary Form

Waiver of Health Coverage

24 Hour Notification of Incident/Injury

457 Deferred Compensation Authorization Form for Non-Classified employees

457 Deferred Compensation Authorization Form for Classified Employees (PDF)

10/05/2007