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Ant: Read instructions on the Back of Part 2 before completing this form. (DO NOT erase or cross-out. Use a new form.) A. Information About the Insured (not the Assignee, if there is one) (type or print) Name of Insured (Last, first, middle) The Insured is: Place an "X" in the appropriate box. Date of birth of Insured (mm/dd/yyyy) an employee Social Security Number of Insured If the Insured is retired or receiving Federal Employees' Compensation, give CSA, CSI, or OWCP claim number: a r.

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You can write to the Office of Personnel Management at OPM, P.O. Box 45, Boyers, PA 16017-0045, call OPM's Retirement Information Office at 1-888-767-6738, or send us email at retire@opm.gov.

FEGLI enrollees and assignees use this form to designate who should receive the death benefits. NOT required if the enrollee or assignee has not filed a previous designation of beneficiary and is satisfied with the standard order of precedence .

Submit the designation form to: Office of Personnel Management, Retirement Operations Center, P.O. Box 45, Boyers, PA 16017-0045.

How can I contact the Office of Federal Employees' Group Life Insurance (OFEGLI)? OFEGLI's address is OFEGLI, P.O. BOX 6080, SCRANTON, PA 18505-6080. Their phone number is 1-800-633-4542.

Its address is P.O. Box 6080, Scranton, PA 18505-6080; for overnight deliveries only, the address is 10 Ed Preate Dr., Moosic, PA 18507. Phone (800) 633-4542, fax (570) 558-8659, online .opm.gov/healthcare-insurance/life-insurance.

Name a Trust Provide the following information on the beneficiary designation: The full name of the trust as it shows on the trust document. The date the trust was created. The name of the trustee, followed by the word “trustee,” or if you cannot provide a trustee, ETF may accept another contact person.

Visit the Federal Employees' Group Life Insurance Program homepage for more information about life insurance. Please contact FEGLI at fegli@opm.gov, your employing agency, or OPM at 1-888-767-6738 if you have questions.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232