Form 2802 - Notice To Terminate A Met Limited Benefits Plan Contract - 1997
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1
2Michigan Education Trust
2802 (4-97) Formerly T-1050
NOTICE TO TERMINATE A MET LIMITED BENEFITS PLAN CONTRACT
This form is issued under the authority of P.A. 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 (student) Name
Contract Number
Street Address
Beneficiary's Social Security Number
City, State, ZIP
Daytime Telephone Number
(
)
Name of Institution Beneficiary Will Attend
Semester (or Term) and Year Benefits Will be First Used
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 acceptance letter. To whom
should refund be paid?
College
Person in Item 16
b.
Beneficiary will attend an Out-of-State Institution of Higher Education. Attach acceptance letter. To whom
should refund be paid?
College
Person in Item 16
c.
Beneficiary has received a full tuition scholarship. Attach verification of scholarship.
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.
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.
f.
Beneficiary will attend a Community or Junior College and intends to terminate the Contract rather than receive educational
benefits.
g.
Other. Please specify. Attach explanation on a separate page.
*Signature of Beneficiary (student)
Date
*BENEFICIARY MUST BE AT LEAST 18 YEARS OF AGE. 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
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