Follow the steps to submit your application online

1. Click ‘Get Form’ button to access the application and open it in the editing interface.
2. Begin with the 'Notice of Eligibility Statement' section, which must be completed by your employer. This includes providing the employer's name, group policy number, and other employment details.
3. Next, move on to the 'Applicant Information' section. Here, you will enter personal information including the proposed insured's name, date of birth, social security number, and contact information.
4. Fill in the 'Insurance Coverage' section, and specify the amount of insurance you wish to convert, making sure it does not exceed the amount of your prior group coverage.
5. Select the premium payment frequency that suits you best: annual, semi-annual, quarterly, or monthly. Ensure that if opting for monthly, the premium amount meets the minimum requirement of $15.
6. Provide beneficiary information, including names and relationships to the proposed insured. If required, include contingent beneficiaries as well.
7. In the 'Additional Information' section, clarify any relevant details as needed, referring to specific question numbers to maintain clarity.
8. When all sections are filled out, review the application for accuracy, ensuring all required fields are completed.
9. After reviewing, save your changes, then print or share the form as needed, ensuring that it is sent along with your payment to the specified address for processing.

Complete and submit your Application For Conversion Of Group Term Life & Accidental Death Insurance online today.