Enrollment - Firemen's Benevolent Association of Tampa

CHANGE IN CIRCUMSTANCE?

Life is ever-changing. Things such as death, marriage, having a child, divorce, and other events can drastically change your life in the blink of an eye. For this reason, it's important that you regularly review your membership to ensure that your beneficiary designations are up to date.

To provide your most current membership information and/or make changes to your beneficiary designations, please download the ENROLLMENT & BENEFICIARY DESIGNATION FORM from the link provided. Should you prefer to receive the form via postal service please utilize the online request form provided below.

Complete the ENROLLMENT & BENEFICIARY DESIGNATION FORM per the instructions provided, be certain to include all of the required signatures, and mail to:

Firemen’s Benevolent Association
720 E. Zack Street
Tampa, FL 33602

Download Link

Due to the signature requirements, this document must contain ORIGINAL signatures and the ORIGINAL document must be received by the FBA. No reproductions or emailed versions of this form can be accepted.

Name

Phone

Email Address

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

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