Group Life Insurance Forms
Forms may be downloaded by clicking the download links below. To request hardcopy forms, please send an email request via the link in the “Request form via email” column next to the form name. 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 link above. For information on completing forms with Reader® click here.
Forms cannot be saved or altered.
New: A number of forms are now also available for completion online with your digital signature. We refer to these forms as “Digital Signature Forms.” You do not need to print paper to fill out and submit “Digital Signature Forms.” You will have an option to save an electronic copy of any form you opt to fill out electronically and sign digitally.
The Digital Signature Forms are being made available through “Carahsoft OBO Maine Public Employees Retirement System (MainePERS)” using the DocuSign Platform. These forms are located in the table below.
To select and complete an available digital signature form, click on the link in the box under the “Digital Signature Forms” column for that form. Step-by-step directions are available within the form signing process itself.
Click here for more information on digital signatures
Digital Signature:
A digital signature means a computer-created electronic signature that is:
- unique to the person using it;
- intended by the person using it to have the same force and effect as the use of a manual signature;
- capable of verification;
- under the sole control of the person using it; and
- linked to data in such a manner that it is invalidated if changes are made to the data.
Digital signatures require creation by specialized software platforms.
| Form Number | Form Name | Download form as PDF | Request form via email | Digital Signature Forms |
|---|---|---|---|---|
| Application | Application for Portability or Conversion from Group Life Insurance | Download Application | n/a | |
| CL-0893 | Affidavit for Estates Not Exceeding $40,000 | Download CL-0893 | Request CL-0893 | |
| GI-0874 | Request for Basic and/or Additional Insurance Coverage Requiring Evidence of Insurability | Download GI-0874 | Request GI-0874 | Download DocuSign Form GI-0874 |
| GI-0880 | Dependent Insurance | Download GI-0880 | Request GI-0880 | |
| GI-0881 | Cancellation/Reduction in Coverage | Download GI-0881 | Request GI-0881 | |
| GI-0912 | Designation of Beneficiary - Group Life Insurance (Individuals completing this form might also consider completing the Pension Beneficiary Designation for Pre-Retirement Death Benefits form.) | Download GI-0912 | Request GI-0912 | Download DocuSign Form GI-0912 |
| GI-0920 | Third-Party Designation | Download GI-0920 | n/a |
