Get University System Of New Hampshire Voluntary Accidental Death And Dismemberment Enrollment Form

This guide provides clear and step-by-step instructions on how to successfully complete the University System Of New Hampshire Voluntary Accidental Death and Dismemberment Enrollment Form online. By following these instructions, users can ensure their enrollment in the necessary insurance coverage.

Follow the steps to complete the enrollment form effectively.

1. Click the ‘Get Form’ button to obtain the enrollment form and open it for editing. This will provide you with the necessary document to complete your enrollment.
2. In the 'Print Name' field, enter your full legal name as it appears on official documents.
3. Provide your Social Security Number (SSN) in the designated field to ensure accurate identification.
4. Fill in your campus address accurately to ensure correspondence is sent to the correct location.
5. Select your campus from the provided options by marking the appropriate checkbox for UNH, PSU, KSC, GSC, or SYS.
6. Indicate your desired amount of optional Accidental Death and Dismemberment (AD&D) life insurance coverage by checking the corresponding box next to your chosen amount ($50,000, $100,000, or $150,000).
7. Allot the necessary contributions to be deducted from your salary as stated next to your selected coverage amount.
8. Designate your primary beneficiary(ies) by entering their name(s) in the provided space. This ensures that benefits are directed to the intended individual(s).
9. If applicable, designate your contingent beneficiary(ies) in the same manner as the primary beneficiary(ies) to ensure a backup recipient is in place.
10. For each beneficiary, include their relationship to you and their date of birth in the designated fields to validate the information.
11. Review the note regarding the beneficiary payout process to understand the hierarchy in the case of multiple beneficiaries.
12. Provide your signature and the date in the appropriate fields to authenticate your enrollment and agreement to the policy.
13. Finally, after reviewing all your entries for accuracy, save any changes, download, print, or share the completed form as needed for your records.

Complete your form online today to secure your coverage and peace of mind.