ENROLLMENT FORMS - TERM LIFE INSURANCE PLAN

Term Life Insurance forms:

NOTE: Employees of FBI, USSS, DEA, ATF, CBP, CIS, and ICE must complete the Biweekly Enrollment form and Allotment Form 299. All other agencies must complete the Monthly Enrollment Form and Direct Debit application.

Form Description PDF Premium
Biweekly Enrollment Form
Monthly Enrollment Form
Short Form Health Statement*
Long Form Health Statement**
Beneficiary Form
Allotment Form 299
Direct Debit Application Form

* Use a Short Form if you are age 55 or younger and are applying for $150,000.

** Use a Long Form if you are age 56 or older for any coverage amount; or any age if applying for more than $150,000 coverage.


 

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