Get Request For Assessment - La Capitale

This guide provides clear, step-by-step instructions for filling out the Request For Assessment - La Capitale form online. Our objective is to assist you in understanding each section to ensure a complete and accurate submission.

Follow the steps to successfully complete the Request For Assessment - La Capitale form.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred online document editor.
2. Fill in your information in Section 1, which requires details about the participant. Include your employee number, name, gender, address, and contact information.
3. Complete Section 2, focusing on the insurance plans. Select one health insurance plan and, if applicable, indicate your level of desired life insurance coverage.
4. In Section 3, provide any modifications to your group insurance. State the reason for modification and include the expected date of return to work if applicable.
5. For Section 4, enter information about your dependents, including their names, genders, and dates of birth.
6. In Section 5, designate a beneficiary for life insurance coverage. Clearly note their full name along with your relationship to them.
7. Read and sign Section 6, confirming your understanding and agreement to the terms. Include the date to finalize your declaration.
8. Your employer’s representative must fill out Section 7. Ensure this section is completed before submitting.
9. Once all sections are completed, you can save your changes, download the document, print it, or share it as needed.

Complete your documents online today to ensure timely processing of your assessment.