U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

Life Insurance Forms

Unless otherwise noted, the following life insurance forms and publications are available at www.opm.gov/insure/life. You may also wish to check with your human resources office. Some agencies have automated versions of some of these forms.

Standard Forms

SF 2817     Life Insurance Election

SF 2818     Continuation of Life Insurance Coverage As an Annuitant or Compensationer

SF 2819     Notice of Conversion Privilege

SF 2820     Certification of Insured Employee's Retired Status

SF 2821     Agency Certification of Insurance Status

SF 2822*    Request for Insurance

SF 2823     Designation of Beneficiary

Office of Personnel Management Forms

OPM 1482     Agency Certification of Status of Reemployed Annuitants

RI 76-10         Assignment, Federal Employees' Group Life Insurance

Office of Federal Employees' Group Life Insurance Forms

FE-6             Claim for Death Benefits

FE-6DEP     Statement of Claim — Option C

FE-7             Claim for Accidental Dismemberment

E-8†             Claim for Living Benefits

Booklets, Pamphlets, and Handbooks

RI 76-12     FEGLI Pamphlet for Retirees

FE 76-20     FEGLI Program Booklet (U.S. Postal Service)

FE 76-21     FEGLI Program Booklet (Federal)

RI 76-26*    FEGLI Handbook

* Available in electronic format only at www.opm.gov/insure/life.

† Available only from the Office of Federal Employees' Group Life Insurance (OFEGLI) by calling 1-800-633-4542.

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