Physician Certificate for Child Annuitant

     

Month XX, 20XX

     

     

     

     

Dear      :

This correspondence is in reference to your recent request. We need additional information before we can update your account. Please provide the information on the enclosed form and return it in the envelope we have provided.

Full first name, middle initial and last name: Box    

Social Security Number (SSN) of the annuitant: Box     

Social Security Number (SSN) of the retiree: Box     

The following supporting document(s):      .

Complete, sign and return enclosed form(s).

Signature required.

Other:      .

If you have any further questions, you can contact one of our customer care representatives at 800‑321‑1080 or 216-522-5955, between 8:00 a.m. and 5:00 p.m., Eastern Standard Time, Monday through Friday, or write to us at the address above.

Sincerely,

     

Retired and Annuitant Pay

Enclosures:

As stated