Group Life Insurance Forms

Forms - Group Life Insurance

Forms may be downloaded by clicking the corresponding form number below. The "Request Forms" e-mail is for ordering hardcopy forms only. For all other inquiries, please contact MainePERS directly.

To use these forms you will need Adobe Reader^®. If you don't have Reader, you can get it free by clicking the Adobe icon to the right.

Adobe.com

GI-0908+	Application for Coverage Group Life Insurance	Request Form
GI-0881+	Cancellation/Reduction in Coverage	Request Form
GI-0880+	Dependent Insurance	Request Form
GI-0912+	Designation of Beneficiary - Group Life Insurance (Individuals completing this form might also consider completing the Designation of Beneficiary Pre-Retirement Death Benefits form.)	Request Form
CL-0068	Group Life Insurance Advisory	Request Form
GI-0874+	Request for Basic and/or Additional Insurance Coverage Requiring Evidence of Insurability	Request Form

+ Forms indicated with "+" may be viewed and completed on the screen using a recent version of Adobe^® Reader^®, printed, and mailed to the MainePERS. You may click on any line to complete that area or use TAB to move forward and SHIFT-TAB to move back. Forms cannot be saved or altered.