Get Basic Life (includes Accidental Death And Dismemberment) And Additional Contributory Life

Filling out the BASIC LIFE (INCLUDES ACCIDENTAL DEATH AND DISMEMBERMENT) AND ADDITIONAL CONTRIBUTORY LIFE enrollment form online is a straightforward process. This guide will help you navigate each section of the form, ensuring you complete it accurately and efficiently.

Follow the steps to complete your enrollment form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your full name in the designated field, including your last name, first name, and middle initial.
3. Provide your employee number in the specified section to verify your employment and ensure proper processing of your application.
4. Indicate your choice for Basic Life Insurance. Remember, this insurance is provided at no cost to you, covering 1.5 times your base salary up to a maximum of $600,000.
5. List your beneficiaries for the Basic Life Insurance. Include each beneficiary's name, selecting whether they are a primary or contingent beneficiary, along with their relationship to you.
6. Fill in the Social Security number and date of birth for each beneficiary listed, as these details are required for proper identification.
7. If you wish to enroll in Additional Contributory Life Insurance, select the desired coverage amount based on your base annual earnings and acknowledge the associated cost.
8. Repeat the beneficiary listing for the Additional Contributory Life Insurance section, including all necessary details as required.
9. Sign and date the form in the employee signature section, indicating your authorization for the coverage you have selected.
10. Once you have completed the form, ensure all information is correct. Save your changes and download or print the form for your records.

Start completing your BASIC LIFE and ADDITIONAL CONTRIBUTORY LIFE enrollment form online today.