Dental Plan Forms

This page provides a description of and links to National IAM Benefit Trust Fund forms related to Fund dental plans. Click the form titles below to review or download copies.

Authorization Form

Authorization Form (PDF)

Cancellation of Authorization Form

Cancellation of Authorization Form (PDF)

Disabled Dependent Certification Form

Disabled Dependent Certification Form (PDF)

Eligible Dependent Certification Form

Eligible Dependent Certification Form (PDF)

Enrollment Form

Enrollment Form (PDF)

Dental Claim Form

Dental Claim Form (PDF)

Waiver Form

Waiver Form (PDF)