ENROLLMENT FORMS - PERSONAL ACCIDENT INSURANCE
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Personal Accident Insurance (PAI) forms:
NOTE:  Employees of FBI, USSS, DEA, ATF, CBP, CIS, and ICE must complete the SAMBA Payroll Allotment Form 299.  All other agencies must complete the Direct Debit application.
Form Description PDF Type Premium
PAI Active Member Enrollment Form
PAI Monthly Enrollment Form  
Beneficiary Form
Allotment Form 299
Direct Debit Application Form



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