Form 2802 - Notice To Terminate A Met Limited Benefits Plan Contract

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Michigan Department of Treasury
2802 (Rev. 1-04)
Notice to Terminate a MET Limited Benefits Plan Contract
Issued under Public Act 316 of 1986.
Use this notice when attending a Michigan independent or out-of-state institution OR to receive a refund. Submit this
notice to MET by July 15 before the Academic Year in which you, the Beneficiary, wish to terminate the Contract.
*Beneficiary Name (Student)
Contract Number
Street Address
Beneficiary's Social Security Number
City, State, ZIP Code
Daytime Telephone
(
)
Name of Institution Beneficiary Will Attend
Semester and Year To Begin Using Refund (Required Information)
The beneficiary requests termination of the above referenced contract for the following reason:
_____
a.
Beneficiary will attend a Michigan Independent, Degree-granting College or University.
Attach 1)
Acceptance letter, 2) W-9 form for beneficiary and 3) W-9 form for refund designee (regardless of where
you direct refund). To whom should refund be paid?
____ College ____ Refund Designee (Person in Item 16 of Contract Signature Page)
_____
b.
Beneficiary will attend an Out-of-State Institution of Higher Education. Attach 1) Acceptance letter, 2) W-9
form for beneficiary and 3) W-9 form for refund designee (regardless of where you direct refund). To
whom should refund be paid?
____ College ____ Refund Designee (Person in Item 16 of Contract Signature Page)
_____
c.
Beneficiary has received a full tuition scholarship. Attach 1) Verification of scholarship that states terms
(what costs will be covered per term/semester as well as number of terms/semesters covered or terms of
renewal), and 2) W-9 form for refund designee.
_____
d.
Beneficiary does not plan to attend a Higher Education Institution. Complete the affidavit on the reverse
side of this form stating that you, the Beneficiary, do not plan to attend a Higher Education Institution. The
affidavit must be notarized. Attach 1) Notarized affidavit, and 2) W-9 form for refund designee.
_____
e.
Beneficiary is Disabled or has died. (This request can be made at any time.) Attach a sworn or attested
statement of the Beneficiary's Disability. If the Beneficiary died, the person with legal authority to act on
behalf of the Beneficiary should submit a certificate of death and sign the form below in place of the
Beneficiary's signature. A W-9 form must be submitted for the refund designee in either case.
_____
f.
Beneficiary will attend a Community College and intends to terminate the Contract rather t h an receive
educational benefits. Refund must be provided to the Community College. Attach W-9 form for refund
designee.
_____
g.
Military. Attach 1) Copy of enlistment contract and 2) W-9 form for refund designee.
If you are unsure of the appropriate reason for termination please call the MET Policy Analyst at (800)-638-4543.
*Signature of Beneficiary (Student)
Date
*Beneficiary must be at least 18 years of age or have a high school diploma. If you are not 18 years of age, attach a copy of
your high school diploma.
MAIL TO:
Michigan Education Trust, P.O. Box 30198
Lansing, Michigan 48909
17

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