INSTRUCTIONS: SOUTHLAND NATIONAL SUPPLEMENTAL VISION INSURANCE ENROLLMENT/CANCELLATION FORM (Form IB20)

Alabama state employees who wish to enroll in state-administered supplemental vision insurance do so by filing a form IB20. This document can be obtained from the website of the Alabama State Employees' Insurance board.

Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 1: On the first line, enter your name, sex, and the date you wish for the coverage to take effect.

Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 2: On the second line, give your Social Security number and date of birth.

Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 3: On the third line, give your mailing address.

Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 4: On the fourth line, give your city, state and zip code.

Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 5: On the fifth line, give your home and work telephone numbers.

Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 6: On the sixth line, give your email address.

Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 7: In the box on the right, indicate with a check mark if you are seeking single or family vision coverage or whether you are filing this form to cancel coverage currently in effect.

Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 8: If you are seeking family coverage, you must detail your dependents. In the first column on the first line, enter the first name, middle initial and last name of your husband or wife. In the second column, circle "Husband" or "Wife" as applicable. In the third column, enter their date of birth. In the fourth column, enter their Social Security number.

Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 9: The next three lines require you to enter the same information for any sons, daughters, stepsons or stepdaughters.

Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 10: The last two lines provided require you to enter the same information for any grandsons, granddaughters, nephews and nieces.

Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 11: Sign and date the bottom of the first page. Mail the completed document to the address at the bottom of the second page.