Group Term Life Insurance Application Please complete and return this form to: Worldwide Assurance for Employees of Public Agencies (WA EPA) 433 Park Ave., Falls Church, VA 22046 (800)3683484 www.waepa.org.

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How to fill out the GMA-AC-IR online

This guide provides clear, step-by-step instructions on how to complete the GMA-AC-IR form online. Whether you are familiar with insurance applications or new to the process, this comprehensive resource will help you navigate each section with confidence.

Follow the steps to complete your GMA-AC-IR online.

  1. Press the ‘Get Form’ button to obtain the GMA-AC-IR form and open it in your preferred online document editor.
  2. Begin by filling in your personal details, including your full name, date of birth, height, and weight in the designated fields.
  3. Provide your contact information, including your billing address, city, state, home phone number, and email address.
  4. Indicate your marital status by selecting the appropriate option. If applicable, include your maiden name.
  5. Answer the question about whether you intend to reside outside the U.S. in the next 12 months, and specify your current country of residence.
  6. If you are requesting dependent coverage, list the eligible dependents by entering their names, dates of birth, and social security numbers as required.
  7. Designate your beneficiaries by providing their full names, relationships to you, and complete addresses in the sections provided.
  8. Select the type of group insurance coverage you are applying for, specifying whether you are seeking new or additional coverage.
  9. Complete the insurance replacement section if applicable, answering the questions regarding existing insurance policies.
  10. Fill in the payment options section, indicating your preferred method of payment for the insurance premiums.
  11. Review your application for any errors or omissions, making corrections as necessary before signing and dating the application.
  12. Finalize your form by saving your changes, and prepare to download, print, or share the completed form as needed.

Complete your GMA-AC-IR application online today for efficient processing.

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