Get VA 29-4364 2021
Reginfo. gov/public/do/PRAMain. If desired you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form. VA FORM 29-4364 DEC 2010. For example Mary Rose Smith not Mrs. John Smith PRINCIPAL Beneficiary s Social Security Number If known. This is not required for this designation to be valid Relationship of the beneficiary to you Share to be paid to Use amounts or fractions Payment Option for Each Beneficiary See pamphlet for more information Lump Sum Or to survivors Contingent Person s who get the proceeds if the principal CONTINGENT VA FORM DEC 2010 29-4364 EXISTING STOCK OF VA FORM 29-4364 DEC 2003 WILL BE USED. OMB Approved No* 2900-0068 Respondent Burden 20 minutes APPLICATION FOR SERVICE-DISABLED VETERANS INSURANCE IMPORTANT INFORMATION Eligibility S-DVI provides up to 10 000 of life insurance for eligible veterans. To be eligible for S-DVI you must meet all three of the following requirements 1. You were released from active service in the Armed Forces on or after April 25 1951 under other than dishonorable conditions. 2. It has been less than 2 years since VA notified you of a new service-connected disability or you are currently waiting for a rating for your service-connected disability. Please Note The disability you are rated for must be a new disability not an increase in a disability you already have. An increase to 100 or being granted individual unemployability does not automatically entitle you to a new eligibility period. 3. You are in good health except for your service-connected disability. We will evaluate all health conditions that are not serviceconnected* Information about any health conditions should be included on your application* Cost Before you apply for S-DVI coverage we encourage you to compare our premium rates to commercial insurance companies. If your disability is not serious you may be able to find better rates from a commercial company. When considering the cost of S-DVI coverage remember that if you are or become totally disabled and unable to work for six or more months you do not have to pay premiums on your Government Life Insurance policy. Most commercial life insurance companies add an additional charge for this benefit. Speeding Up the Application Process We can process your application more quickly if you send us a copy of the letter from VA that first notified that your disability was rated service-connected within the last two years. You may also apply online by visiting our website at www. insurance. va*gov and clicking Apply for Service-Disabled Veterans Insurance Online. Mailing Address If you meet these criteria please complete and sign the application and then send immediately to Department of Veterans Affairs Regional Office and Insurance Center RH P. O. Box 7208 Philadelphia PA 19101 or fax to 1-888-748-5822. Questions If you have questions about Government Life Insurance you can call us toll-free at 1-800-669-8477 or visit our website at www. insurance. va*gov* PLEASE BE SURE TO COMPLETE BOTH SIDES OF THIS 1. Name and Mailing Address for Insurance Purposes A.
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