Get Employee Application - Coroflot

Filling out the Employee Application - Coroflot online can be a straightforward process if you follow the right steps. This guide is designed to help you complete the application accurately and efficiently, ensuring that all necessary information is provided.

Follow the steps to complete the application form successfully.

1. Press the ‘Get Form’ button to access the application form. Open the form in your chosen online editor.
2. Begin with SECTION A, which is to be completed by the employer or group, including the group number, division number, class, and requested effective date.
3. Proceed to SECTION B for applicant information. Fill in the reason for application by selecting one of the options provided, and complete all personal information fields including your last name, first name, street address, social security number, and home telephone number.
4. Indicate your employment status by answering whether you are actively at work and if you are retired. Fill in the relevant details such as occupation, current income, and marital status.
5. Provide details about any dependents you wish to include in the coverage by filling out their names, social security numbers, dates of birth, sex, and their relationship to you.
6. Move to SECTION C, where you will report any status changes, selecting the reason for changes as applicable and filling in the relevant date and information.
7. In SECTION D, list the primary and contingent beneficiaries’ names, ages, and relationships.
8. In SECTION E, check all insurance coverages you are applying for based on the options provided.
9. If applicable, complete SECTION F regarding portability options, including termination date and payment mode preferences.
10. Review SECTION G to understand the authorization statement thoroughly. Sign where indicated for yourself and your spouse, if applicable.
11. If you are waiving life coverage, navigate to SECTION H and provide your printed name, social security number, signature, and date.
12. Finally, ensure all information is correct, and save changes to your application. You will have the option to download, print, or share the completed form as necessary.

Begin completing your Employee Application - Coroflot online today and ensure all your information is accurate.