Get Enrollment And Beneficiary Form - Ullico

Filling out the enrollment and beneficiary form is a critical step in managing your insurance and beneficiary information effectively. This guide provides clear, step-by-step instructions to help you navigate the form online with confidence.

Follow the steps to complete your form online.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Review the instructions at the top of the form, which detail whether you are submitting a new enrollment, reinstatement, address change, or beneficiary change.
3. In Section A, input the policyholder information, including the name of the group policyholder, policy number, effective date, and local/bill ID.
4. Proceed to Section B and enter the insurance amounts for life coverage, accidental death and dismemberment (AD&D), accidental health (AH), and long-term disability (LTD) as applicable. Also, check your billing classes.
5. In Section C, provide the insured information: name (last, first, middle), address, city, state, Social Security number (SSN), date of birth, occupation, weekly earnings, and the date the person started working.
6. Move to Section D to designate the beneficiary(ies). Enter their names, relationship to the insured, and dates of birth as necessary, ensuring to outline the percentage allocation for each beneficiary.
7. Ensure to sign and date the form where required, including the signature of a witness if applicable.
8. Once all sections are complete, review your entries for accuracy, and then you can choose to save changes, download, print, or share the completed form.

Complete your documents online with confidence today!