F00996 Request for Movement between Domestic and International Administrators for the World Bank Group MIP

Instructions:

Welcome to the World Bank Group HR Forms Instructions page.

This form filler tool is designed to assist you in electronically entering your data and printing a paper form with a unique barcode corresponding to your entered data. Once you've completed your answers and printed the form, you'll need to submit it either by email or in person, depending on the form type.  Please note that the data you enter is directly captured in the form's unique barcode, so it's important that you do not make any handwritten changes, corrections, or additions to the data or to the form after it has been printed. Doing so may result in data errors and processing delays.

In case you notice any errors after printing your form, or if you've left a field blank, we recommend starting over and completing a new form. It's also important to remember that your information is not saved by the form filler and can no longer be accessed after you print it. Therefore, please be extra careful in reviewing your answers, as it is impossible to make any corrections after the form is printed.

Each form will take approximately ten minutes to complete. Please ensure you have the needed documents such as passport to extract information that may be required in some fields. Do not close the forms until they are ready for a download. Partially filled forms cannot be saved to be completed later. If you need further assistance, please contact. Thank you!

Information on Completing the Form

1) Return all pages of this form to HR Operations (Select one transmittal format, and submit only once):

a.  E-mail at hroperations@worldbank.org          

b.  Fax +1 (202) 522-7026

2) For more information refer to the checklist. 

Requests are processed throughout the calendar year. You will receive a confirmation e-mail from HR Operations after your request is processed.

Need Help? 

If you are experiencing any issues, please contact HR Operations via email: hroperations@worldbank.org  or phone 202-473-2222 or 5220+32222.

Revision 25 Apr 2023

Staff Information

World Bank Group UPI*

First Name*

Middle Name

Last Name*

Staff Member Name (Last, First, Middle)*

Current Status

Current Status (please check one)*

Non HQ Duty Station*

Start Date in Duty Station*

Change Enrollment

2. Please change my enrollment as follows (please check one):

Active staff in Option C only, please select new option

Active staff only, please select new option

If you elect Option C, you must contact Aetna Member Services at 202-473-8666 the first Thursday after your effective date of transfer to register a Primary Care Physician (PCP) for you and eligible dependents. Until you perform this registration, all preferred-provider medical services except routine OB/GYN, routine eye care and mental health services will be considered "non-network."

Certification

Signature of Staff Member

Date

After filling this document, you must sign and date it before returning this document to the World Bank Group. Please ensure ALL information in the submission form is complete and accurate before printing the form. This will generate your form(s) as a PDF file. Review the file for accuracy and completeness. If there is an error, please start a new form.