Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to retrieve the Desjardinslifecomplanmember Form and access it in your preferred editor.
2. Begin with section A - Identification. Fill in details such as the name of the policyholder, group number, member's last and first name, date of birth, and address. Ensure the information is printed clearly to avoid errors.
3. Continue in section A by providing your annual salary, class, and employment details such as your date of employment, number of hours worked weekly, and the eligibility date.
4. In section A, indicate your coverage preference (individual, family, couple, or single-parent) and whether you would like to select basic life insurance for your dependents if your plan allows.
5. Proceed to section B - Request for Exemption. Decide if you wish to waive coverage under extended health care and dental care, confirming that you are covered by another plan if you select 'yes.'
6. Complete section C - Identification of Dependents if you have selected family, single-parent, or couple coverage. Provide the required information for each dependent, including their date of birth and information about any other insurance they may have.
7. In section D - Optional Benefits, review the provisions under your plan and indicate desired coverage for optional life, accidental death and dismemberment (AD&D), and critical illness benefits. Complete any required related forms if you select specific optional benefits.
8. Section E - Designation of Beneficiary(ies) requires you to specify beneficiaries and their relationships. Include information about any minor beneficiaries and any required trustee designations.
9. In section F, complete the Declaration and Authorization for the Collection and Communication of Personal Information. Ensure you provide your signature along with any authorized person’s signature, if applicable.
10. Finally, review all entries for accuracy, save your changes, and proceed to download, print, or share the completed form as necessary.

Start completing your Desjardinslifecomplanmember Form online now.