Benefits & Leave Forms
Below you will find commonly used Insurance, Retirement and Flexible Spending Account Forms. In addition, there may be times that you have to obtain forms directly from some benefit vendors. Here are links to certain vendor Web sites:
- NCFlex Benefit Plan Forms
- Teachers’ and State Employees’ Retirement System Forms
- State Health Plan of North Carolina
- Acknowledgement of Offer and Optional Waiver to Decline Coverage
- Affidavit For Domestic Partner
- Lincoln Financial Disability Evidence of Insurability Form
- Lincoln Financial Disability Claim Form
- Lincoln Financial Disability Enrollment Form
- MetLife Absolute Assignment Form
- MetLife Beneficiary Designation Form
- MetLife Certificate Rider
- MetLife Conversion & Portability Chart
- MetLife Enrollment/Change Form
- MetLife Plan Summary and Rates
- MetLife Statement of Health Form
- MetLife Will Preparation & Estate Resolution
- Reliance Standard AD&D Enrollment Form
- The Standard Enrollment/Change Form
- The Standard Medical Statement Form
- MetLife Dental Domestic Partner Enrollment Form
- 403b Salary Reduction Agreement Form
- ORP-1 Election of the UNC Optional Retirement Program (Please enroll through Connect Carolina Self Service)
- ORP-2 Notice of Change in Election for the UNC ORP
- ORP-3 Acknowledgement of Disposition of Account Contributions for the UNC ORP
- Retirement Election Form
- NC 457b Deferred Compensation Plan Enrollment Form
- NC-401k Enrollment Form
- UNC System 457(b) Salary Deferral Agreement Form
- Attestation of In Loco Parentis Relationship
- Certification for Serious Injury of Illness of Covered Service Member for Military Family Leave (WH-385)
- Certification of Qualifying Exigency For Military Family Leave (WH-384)
- Creditable Service Form
- Family & Medical Leave Request Form
- Families First Coronavirus Response Act (FFCRA) Request Form (Updated 6/26/20)
- Medical Certification- Employee
- Medical Certification- Family Member
- Medical Leave Return To Work Form
- Paid Parental Leave Request Form
- Voluntary Shared Leave (VSL) Donation Form
- Voluntary Shared Leave (VSL) Request Form