Follow the steps to complete your enrollment form.

1. Click the ‘Get Form’ button to access the MetLife EF-XDP441S-NW form in your editor.
2. Begin by providing group customer information, including the name of the group customer or employer, group customer number, division, class, department code, date of hire, and coverage effective date. This information should be completed by the recordkeeper.
3. Next, fill in your enrollment information. Enter your name (first, middle, last), social security number, address (street, city, state, zip code), gender, marital status, date of birth, job title, and basic annual earnings. Indicate whether you are an employee, salaried, retiree, or hourly worker.
4. If applicable, indicate whether you are enrolling or making changes to your enrollment. Specify if you are seeking COBRA continuation and enter the relevant dates for any qualifying events.
5. Answer the hospitalization question to indicate if you, your spouse, or children have been hospitalized in the past 90 days. This is crucial for certain coverage options.
6. Select the type of insurance you are applying for, including term life, accidental death and dismemberment insurance (AD&D), and any supplemental or optional life insurance. Specify the amount requested for each type.
7. Provide dependent information if applicable. Include spouse and children's names, birthdates, and gender.
8. Review and complete the beneficiary designation section where you can specify the primary and contingent beneficiaries for your insurance benefits.
9. Carefully read the declarations and sign the form, affirming that all information is accurate and complete.
10. Once completed, make a copy for your records. You can then save changes, download, print, or share the form as needed before submitting it.

Complete your MetLife EF-XDP441S-NW form online today for a smoother enrollment experience.