Member/Local Beneficiary Form

As a member of a local union affiliated with the American Federation of Teachers, you automatically receive a $5,000 Accidental Death and Dismemberment Policy as part of your membership. Please use the form below to confirm your membership and designate your beneficiary.

This information will be stored on a secure server and only used in the event there is a claim. If you wish to complete a paper form please contact your steward/representative.
 
Your email contact information may be used to inform you of other union benefits and services. Should you get such messages you simply need to unsubscribe if you don’t wish to receive them.

 

About you:
This information is kept on a secure server and is used only in the event of a claim. If you wish to complete a paper form please contact your steward/representative.

The beneficiaries below will share the benefit, these are not a priority or ranking order.