UUP Benefit Trust Fund Group Term Life Beneficiary Form

Please fill out the form below to electronically submit a Beneficiary form for your UUP Benefit Trust Fund Group Term Life Insurance.

To enroll and complete a paper enrollment form HERE and you may email, fax or mail to the UUP Benefit Trust Fund.

Fax: 1-866-559-0516 Mail: Benefit Trust Fund , PO Box 15143, Albany, NY 12212-9954 Email: Benefits@uupmail.org

MetLife Basic Life Insurance

Amount: $10,000



Employee Information:

*First name:  

Middle:  

*Last name:  

*Date of Birth:  

NYS Employee ID:  

*Address:  

*City:  

*State:  

*Zip Code:  

*Campus:  

*Department:  

*Non-SUNY Email:  


*Required

Beneficiary Information:

First name:  

Middle:  

Last name:  

Date of Birth:  

Relationship:  

Address:  

City:  

State:  

Zip Code:  


Add more beneficiaries:   minus (HERE)


*Acceptance of Terms

YES! I Agree that Submission of this form constitutes my consent to online beneficiary designation. You will receive an e-mail confirming receipt of this beneficiary form. Please retain a copy of that e-mail for your records.




* Required


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