LENGTH OF SERVICE AWARD PROGRAM
PARTICIPANT PORTAL
Forms
Forms can be accessed and completed in two ways:
DocuSign: Complete the form entirely online using an e-signature. Clicking this button will take you to the DocuSign website, where you can complete the form. Once submitted, both Hometown Firefighters and the Sponsor will receive the electronically signed form immediately. You’ll also be able to download and save a copy for your records.
PDF File: This option opens a printable PDF version of the form, which contains fillable fields but requires a hand signature. After completing the form, you can either scan and email it to service@hometownfirefighters.com or mail it to:
Hometown Firefighters
5 Orville Drive
Bohemia, NY 11716
LOSAP Beneficiary Form
Please complete this form to designate your LOSAP beneficiaries. This form applies solely to LOSAP death benefits and does not affect any other death benefits. You may name up to two primary and three contingent beneficiaries. For additional beneficiaries, please include an addendum with the required information. If you have any questions, feel free to contact us at service@hometownfirefighters.com
The Standard Life Insurance Beneficiary Form
Please complete this form to designate beneficiaries for your life insurance policy. This form applies exclusively to life insurance beneficiaries and does not affect other death benefits. You may designate up to two primary and two contingent beneficiaries. For additional beneficiaries, please attach an addendum with the necessary details. If you have any questions, contact us at service@hometownfirefighters.com
Arch Beneficiary Form
Use this form to designate beneficiaries for your Accidental Loss of Life Benefit policy. This form applies specifically to this benefit and does not cover other death benefits. You may designate up to two primary and three contingent beneficiaries For additional beneficiaries, please submit an addendum with the required details. If you have any questions, contact us at service@hometownfirefighters.com
Entitlement Forms
Complete this form as you approach the Entitlement Age to initiate your LOSAP benefit payments. If using the DocuSign form, you will need to upload supporting documents—such as proof of birthdate and bank account verification—as images, screenshots, or scans. If you’re unsure how to upload these documents, we recommend using the PDF form instead. The DocuSign version also includes sections for providing Beneficiary and Direct Deposit information.
Change of Address Form
If you’ve recently moved or need to update your mailing address, please complete the Change of Address form. This will ensure that all important communications—such as LOSAP payments, benefits information, and other notices—are sent to your updated address.
Flushing Bank Direct Deposit Form
To update your direct deposit information for LOSAP payments, you can choose either the PDF form or the DocuSign option, depending on your preference. Keeping your direct deposit details current ensures timely and secure payment transfers, reducing the risk of lost or delayed checks. For assistance, feel free to reach out to our support team at
service@hometownfirefighters.com — we’re here to help.
W-9
As part of managing your benefits, you may be required to complete a W-9 form. This form is essential for ensuring that your benefits are processed correctly and that any payments or tax-related information is accurately reported to the IRS.