Get Additional Contributory Life Insurance (acli) Enrollment Form For Spouses And Dependents

Filling out the Additional Contributory Life Insurance (ACLI) Enrollment Form for Spouses and Dependents is a straightforward process that allows you to enroll your loved ones in optional life insurance coverage. Follow this guide for step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to complete the enrollment form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in your last name, first name, and middle name in the designated fields.
3. Enter your employee number accurately to ensure correct processing.
4. Indicate whether you are enrolling for Additional Contributory Life Insurance (ACLI) for your spouse by checking the appropriate box. This coverage is optional and costs $3.60 per month for a value of $20,000.
5. If adding a spouse, provide their full name including last name, first name, and middle initial. Also, specify the relationship and indicate if they are a full-time student.
6. Input the spouse's social security number and date of birth in the required fields.
7. If enrolling dependent children, state their names, relationships, social security numbers, and dates of birth. Ensure that each child is between 7 days and 21 years old, or up to age 25 if they are full-time students.
8. For each child being added, check the box to indicate if they are a son, daughter, stepson, or stepdaughter, and whether they are a full-time student.
9. At the end of the form, sign to authorize the coverage and certify that the information provided is correct. Include the date of your signature.
10. Once all fields are completed, you can save changes, download a copy of the form, print it out, or share it as needed.

Complete your enrollment form online today to secure life insurance coverage for your spouse and dependents.