Insurance Forms and Documents
Resource Type  
Form Type  

Retirement Forms
Defined Benefit Pension
Application for Benefits
This is the application for the Nazarene Single Defined Benefit Plan, formerly the Basic Pension Plan.
Change of Address
This form authorizes P&B to initiate an address change to your account.
Pension Direct Deposit Request (not for 403b Retirement)
As an added service, Pensions and Benefits USA offers to you electronic direct deposit of your monthly pension benefit. If you would like to take advantage of this service, please complete this form.
403(b) Retirement
Beneficiary Designation
Please complete and sign this form if you are opening a new account and want to designate a beneficiary or if you want to change your beneficiary designation on your existing account.
Distribution for Beneficiary
Use this form if you are a beneficiary and wish to have assets transferred to a beneficiary account in your name or request a distribution.
Distribution for Primary Participant
Please call Fidelity at 1-866-NAZARENE (629-2736) to obtain this form.
403(b) Direct Deposit Request (not for Defined Benefit Pension)
Fidelity EFT is a convenient service that enables you to take your periodic payment distributions from your Fidelity retirement account and have your money electronically transferred to your bank account. Use this form to sign-up.
Employer Participation Agreement
IRS regulations require that all Nazarene employers have this participation agreement signed and on file with P&B in order for their pastors/employees to participate in the Nazarene 403(b) Retirement Savings Plan. For more information about this, please read our Employer Participation Agreement FAQ.
Letter of Agreement
Use this form if you wish to direct your employer to reduce your compensation and direct that this compensation become an elective deferral under your Nazarene 403(b) Plan, or if you want to change your existing Agreement.
Minimum Required Distribution
Use this form to calculate and/or distribute MRD payments.
Systematic Distribution
Use this form if you wish to request a systematic distribution from your Church of the Nazarene 403(b) Retirement Savings Plan account.
Insurance Forms
Disability Insurance
Long-Term Disability (LTD) Change Form
Use this form to make changes to preexisting LTD coverage through Pensions and Benefits.
Long-Term Disability Insurance Application
This application is for enrolling in the Nazarene Long-Term Disability (LTD) Insurance Plan.
Life Insurance
Accidental Death and Dismemberment Insurance Application
This application is for enrolling in the Accidental Death and Dismemberment (AD&D) Insurance Plan.
Beneficiary Change/Designation Trust Primary Form
This form is used when designating a trust as the primary beneficiary for the Pastors Life, Pensioners Death Benefit, Supplemental Group Term, District Life, Missionary Life and Accidental Death & Dismemberment insurance plans.
Beneficiary Change/Designation Trust Secondary Form
This form is used when designating a trust as the secondary beneficiary for the Pastors Life, Pensioners Death Benefit, Supplemental Group Term, District Life, Missionary Life and Accidental Death & Dismemberment insurance plans.
Beneficiary Change/Designation Form
This form is used to change or designating beneficiaries for the Pastors Life, Pensioners Death Benefit, Supplemental Group Term, District Life, Missionary Life and Accidental Death & Dismemberment insurance plans.
Evidence of Insurability
This form is used when applying for one of the insurance plans outside of an open enrollment period, more than 90 days past eligibility or if enrolling for an amount above the guaranteed issue amounts.
Pastors Life Insurance Plan/Pensioners Death Benefit Plan Application
This application is for enrolling in the Pastors Life Insurance or Pensioners Death Benefit plans.
Supplemental Group Term Life Insurance Application
This application is for enrolling in the Nazarene Supplemental Group Term Life Insurance Plan.