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

Alabama state employees may enroll or cancel their enrollment in supplemental vision insurance administered by Southland National by filing form IB20. This document can be obtained from the website maintained by the Alabama State Employees' Insurance Board.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 1: Enter your name in the first blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 2: Enter your sex in the second blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 3: Enter the effective date in the third blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 4: Enter your Social Security number in the fourth blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 5: Enter your date of birth in the fifth blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 6: Enter your mailing address in the sixth blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 7: Enter your city in the seventh blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 8: Enter your state in the eighth blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 9: Enter your zip code in the ninth blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 10: Enter your home telephone number in the tenth blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 11: Enter your work telephone number in the eleventh blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 12: Indicate whether you are enrolling for single coverage, family coverage or are cancelling your enrollment with a check mark.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 13: Enter your email address in the next blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 14: If applicable, document all dependents in the table provided.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 15: Enter your signature on the next blank line.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 16: Enter the date on the last blank line.