Federal Employees' Group Life Insurance Program

Request for Insurance

Use:

Federal employees use this form to obtain life insurance coverage by providing medical information.

Electronic Copies:

• PDF Fillable Version: [358 KB]

To use the Adobe Acrobat forms you need the commercial Acrobat software or the free downloadable Acrobat Reader. You can fill in this form on your computer screen before you print it.

Paper Copies:

Paper copies of this form are not available. You MUST use the downloadable Adobe Acrobat PDF version.