Follow the steps to fill out the form accurately.

1. Click ‘Get Form’ button to access the form and open it for online editing.
2. Enter your name in the designated field, including first name, middle initial, and last name.
3. Indicate your sex by selecting either 'M' for male or 'F' for female.
4. Provide your age and date of birth in the specified format (Month/Day/Year).
5. Fill in your employment details, including the date of employment and annual salary.
6. Specify your job duty and enroller code in the corresponding fields.
7. Complete the address section by entering your street address, city, and ZIP code.
8. Enter your phone numbers for work and home as required.
9. Select your long-term disability insurance coverage based on your salary range, choosing from options like BASIC, SUPPLEMENTAL, or both.
10. For term life insurance, check the box for the coverage you want based on your age and enter the related benefits and rates.
11. Designate a beneficiary for the term life insurance by filling in their name, address, and relationship to you.
12. Review the consent and understanding statement, then sign and date the application.
13. Decide if you want optional benefits for additional coverage and indicate your preference.
14. Once all sections are filled out, ensure to save your changes, and then download, print, or share the completed form as needed.

Complete your documents online to ensure a smooth and efficient enrollment process.