Forms | الأمم المتحدة

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Enrolment, change and termination requests

HLIS Application (for US-based plans)

UN WWP Application

UN MIP Application

Short-term Insurance Plan Application

Certification of Insurance Form

Requests during annual enrolment campaign

2025 Annual Enrollment Campaign Form

2025 Deductible Credit Request Form

ASHI

ASHI Application Form

UN MIP ASHI Application Form

Return to ASHI Form

Life Insurance

Life Insurance Application Form

Life Insurance Termination Waiver

Beneficiary Certification Form 1

Beneficiary Certification Form 2

The Hartford Life Insurance PHA/Evidence of Insurability (EOI) Form

Designation of Beneficiary Form

Notice of Conversion and/or Portability Rights

Death Claim Form

Medicare Part B

Medicare Part B Premium Reimbursement Request Form

F.248 Bank Details Form

Declaration of Medicare Part B Ineligibility Form