SUFFOLK COUNTY MUNICIPAL EMPLOYEES BENEFIT FUND

Certificates can only be requested, not printed, from this site.

Instructions: 

After checking to see if you qualify for the benefit, select the type of certificate you would like from the pull-down menu located on line 1.  Enter the name of the person you are requesting the certificate for in the box located on lines A through J (one name per box).  Complete the member information and then select the submit button.  You will receive your certificate within 7 business days of your request.  If for some reason the Fund is not able to issue the certificate or additional information is needed,  the Fund will contact you via the email address you have supplied.

 

Make sure you have your glasses ordered by 12/31/08 in order for you to receive the 2008 Optical benefit

 

(Certificate requests for Legal Service Benefits can be found by clicking here)

 

1.   I am requesting a   *certificate. 

2.  The person(s) I would like the certificate(s) for is (are):

A. *

B.
C.

    

D.
E.    F.
G.    H.
I.    J.
        

MEMBER INFORMATION

Member's Last Name *
Member's First Name *
Middle Initial
Street Address *
City  *
State *
Zip Code *
Member's E-mail
Day Telephone *
 
   

* These Fields Must be Filled in for your Request to be Processed

SUBMIT ONLY ONE FORM  PER CERTIFICATE TYPE


Revised: 10/10/08