WAEPA - Claim Forms

WAEPA Claim Forms

Please notify WAEPA of Member's death before completing any Claim form:

All WAEPA Claim forms are listed below.
Complete all of the information on your selected Claim form.
Click the "Generate PDF Form" button at the bottom of the form.
If you have correctly completed the form, it will be converted to a PDF file for you to print.
Please include with your Claim form a Certified Copy of Certificate of Death and Verification of Member's Federal Employment - Standard Form 50 (Notification of Personnel Action), current pay stub or annuity statement.

Because all claim forms require a notarized signature, please print and mail your claim form to:

WAEPA
433 Park Avenue
Falls Church, VA 22046

Claim Forms
Form Name	Description:
Beneficiary Statement	Use this form if you are the beneficiary, trustee or Administrator of the deceased WAEPA member.
Dependent Group Life Benefits Proofs of Death	Use this form if you are a WAEPA member filing a claim for a deceased dependent covered under your WAEPA certificate.
Multiple Beneficiary Statement	Along with the Beneficiary Statement Use this form if the deceased WAEPA member named Multiple Beneficiaries of his or her WAEPA policy.
Verification of Trust	Along with the Beneficiary Statement Use this form, if a Trust was named as a beneficiary by the deceased Member.

About WAEPA online Claim forms:
The Online WAEPA Forms tool will assist you in completing the claims form by providing help and making sure all the questions are answered correctly. After you click on the 'Generate PDF Form' button, it will create a document in the Adobe Acrobat PDF file format. Most modern web browsers have built-in Adobe Acrobat PDF file support/viewers, and will display the forms correctly.

About Adobe Acrobat Reader:
Adobe PDF Reader (or a third-party PDF reader) ) is required to use these forms online. If you have an older web browser or are having difficulties viewing the PDF file, try downloading and installing the latest Adobe Acrobat PDF viewer (it's free).

About your browser’s security:
The Online WAEPA Forms should work without any problem using a modern web browser and the default settings. However if you have changed the security settings to restrict dynamic content (JavaScript, ASP, etc), the forms will not work. For the Online WAEPA Forms to work correctly, your browser security settings must allow dynamic content (i.e., let scripts run).

If you are still having problems using the forms, there is an alternative "Print Only"
version of each form that does not provide any of the form validation, error checking, required field checking, or help messages. Look at the bottom of the form page for the link to quot;Print Only" version of the form.

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