Follow the steps to complete the GeoBlue Form 54.1404 online.

1. Click the ‘Get Form’ button to obtain the GeoBlue Form 54.1404 and open it for online completion.
2. Begin by filling in your primary applicant information including last name, first name, and middle initial. Ensure you enter your address with the correct city, state, and postal code.
3. Indicate your marital status by selecting either 'Single' or 'Married'. Provide your email address and phone numbers for contact purposes.
4. In the 'Time and Location Status' section, detail how much time you expect to spend outside of your home country in the next 12 months and list the locations.
5. Select your choice of plan from the options provided, marking the appropriate box for either GeoBlue Xplorer Premier or GeoBlue Xplorer Essential, and any additional riders you wish to include.
6. Complete the 'Applicants for Coverage' section. List all individuals applying for coverage, stating their relationship to you, along with their names, dates of birth, social security numbers, height, and weight.
7. Answer all questions in the 'Other Coverage' and 'Health History' sections completely, providing any necessary details for the questions asked.
8. Review the Conditions of Application thoroughly, ensuring you understand your obligations and the implications of the information provided.
9. Sign and date the application in the appropriate sections, acknowledging that all information is true and complete.
10. Finally, save your changes, and if required, download, print, or share the form as necessary. Ensure that the application is submitted within the specified timeframe.

Take the next step towards your health coverage by completing the GeoBlue Form 54.1404 online today.