Death Benefit

Your eligibility for SEBF benefits are set forth in your collective bargaining agreement or participation agreement that applies to your employment. The following is information regarding the SEBF death benefit.

SEBF provides a death benefit for eligible active members. The benefit and the amount must be bargained into your collective bargaining agreement to be eligible.

The death benefit is paid directly from the Fund and is payable to your named beneficiary if you die while eligible for these benefits.

SEBF also provides a dependent death benefit of $1,000 if negotiated into the collective bargaining agreement. A dependent can include a spouse, domestic partner, or dependent child.

Death Benefit Outline

Make sure your beneficiaries are up to date!

Click on the link below to print a Beneficiary Designation form to complete and return to:

Service Employees Benefit Fund
PO Box 1240
Syracuse NY 13201

Or FAX it to (315) 701-0686

Beneficiary Designation Form

Employers with the SEBF Death Benefit

ABM @ NYSUT CNY
ABM Western NY
Compass @ D'Youville
Contract Specialists
First Class Maintenance Buffalo
First Class Maintenance Syracuse
First Student Auburn- Medical (Mechanics)
GDI Services

Global Services
Hamilton, Village of
Jewish Home Homecare
Jewish Home Menorah Park
Jewish Home of CNY
Jewish Home the Inn
JLL
Oakwood Cemetery

Oaks at Dewitt
Quest Services
SEBF
SEPF
Sodexo @ Clarkson
SP Plus
UG2 @ Lemoyne College

Death Benefit Beneficiary Designation Form

Please fill out the form below. Form field entries ARE encrypted on submission, and the email is sent over an encrypted channel.

Name of Member(Required)

First Last

Social Security Number(Required)

Address of Member(Required)

Street Address Address Line 2 City State ZIP Code

Member’s Date of Birth(Required)

Member’s Date of Hire(Required)

I want the following person(s) listed as my beneficiary(ies) for any death benefit provided by the Service Employees Benefit Fund (SEBF).

Name of Primary Beneficiary(Required)

First Last

Relationship(Required)

Percentage *(Required)

Beneficiary's Address(Required)

Street Address Address Line 2 City State ZIP Code

Beneficiary's SSN(Required)

Beneficiary's Birthdate(Required)

Beneficiary's Phone(Required)

Split between 2 Beneficiaries?

Yes

Name of Primary Beneficiary(Required)

First Last

Relationship(Required)

Percentage *(Required)

Beneficiary's Address(Required)

Street Address Address Line 2 City State ZIP Code

Beneficiary's SSN(Required)

Beneficiary's Birthdate(Required)

Beneficiary's Phone(Required)

*Total Percentage must equal 100%

NOTE: If the Primary Beneficiary predeceases the member, the Death Benefit will be payable to the Contingent Beneficiary.

Name of Contingent Beneficiary(Required)

First Last

Relationship(Required)

Beneficiary's Address(Required)

Street Address Address Line 2 City State ZIP Code

Beneficiary's SSN(Required)

Beneficiary's Birthdate(Required)

Beneficiary's Phone(Required)

I understand this will cancel any previous beneficiary designation(s) for death benefits that I may have made through SEBF. I reserve the right to change my SEBF Death Benefit beneficiary(ies) at any future date.

I understand that if I die as an eligible member without naming a beneficiary, or if my named beneficiary predeceases me and I fail to name a new one, any death benefit will be paid to my estate.

Member’s Signature(Required)

I also agree that by entering my name and date in the boxes below that I am the party responsible for submitting this information to the SEBF and that this may serve as my electronic signature.

Date(Required)

Comments

This field is for validation purposes and should be left unchanged.

Death Benefit

Make sure your beneficiaries are up to date!

Employers with the SEBF Death Benefit

Death Benefit Beneficiary Designation Form

Syracuse Office

Buffalo Office

Additional Resources