Get Basic Life Insurance Enrollment Form - Dps109 - Dps109

Filling out the Basic Life Insurance Enrollment Form - DPS109 - Dps109 is an important step in securing your life insurance coverage. This guide will provide you with clear, step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to fill out the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by completing the Employee Section. Provide your last name, first name, and middle initial in the designated fields.
3. Enter your birth date, ensuring you follow the format for month, day, and year. Include your Social Security number as requested.
4. Indicate your sex by checking the appropriate box for either male or female.
5. List the full names, relationships, and percentages of proceeds for all designated beneficiaries in the provided fields.
6. In the coverage section, indicate your request for Life/AD&D, Weekly Income, or Long Term Disability by checking the appropriate boxes.
7. Confirm your authorization for your employer to deduct necessary premiums from your salary by signing your name and dating the document.
8. If you choose to decline coverage, navigate to the Declination of Group Insurance Coverage section. Fill in your details as previously described and indicate your decision to decline.
9. Complete the signature section for the declination, ensuring it is dated.
10. Once all fields are completed, review your entries for accuracy before proceeding to save, download, print, or share the form as needed.

Begin the enrollment process now by completing the Basic Life Insurance Enrollment Form online.