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Download the Servicemembers’ Group Life Insurance (SGLI) Election and Certificate Form that is created so that service members can restore or make changes to their life insurance. Whether you need to update the beneficiary, increase the amount or even decline coverage complete this form for assistance. Once completed, submit the form and the appropriate changes will be made according to the subscriber’s wishes.

How To Write

Step 1 – Section 1 – About You –

Provide all of the information in the blocks provided:

  • Print name (First, Middle, Last)
  • Rank, title or grade
  • Social Security Number
  • Duty Location
  • Branch of Service
  • Current Amount of SGLI

Step 2 – Section 2 – About Your Coverage –

This form will replace all prior designations.

  • I am completing this form to:
  • Check the boxes that apply to your changes

Step 3 – Section 3 – About Your Beneficiaries –

Always complete this section, unless you are declining coverage. Read the information on page 3 prior to selecting beneficiaries. If you do not provide the names of the beneficiaries, your life insurance will be paid according to law and not your decisions.

  • Provide the following information for all of your beneficiaries whether it’s one person or more. Complete both the primary and secondary beneficiaries in the event someone you’ve selected is not available to collect your insurance for whatever reason -Primary Recipients -

Primary Recipients –

  • Name and address – Social Security Number – Relationship to you
  • Specify the percentage you wish to go to each person until you’ve reach 100%.
  • Specify if you would like your beneficiaries to receive a lump some of their share of the policy or if you would prefer that it pay out in payments over a 36 month period

Secondary Recipients –

  • These are the people who would collect the share of a primary recipient in the event that the beneficiary precedes you in death
  • Continue to provide the same information for secondaries as you are providing for primary beneficiaries.

Have More Beneficiaries? –

  • If you find that there is not enough room for whom you choose as beneficiaries, add a sheet with the exact same information so that they may be added into the system
  • Check the box to the left if you are submitting more beneficiaries

Step 4 – Section 4 – About Your Health –

  • Enter the following information into the blocks provided:
  • Your date of birth mm/dd/yyyy
  • Your weight
  • Your height
  • Your Gender (check one)
  • Answer the following by checking the boxes that apply to you personally -
  • If you answered “yes” to any of the questions, reference the question by letter and list date, duration and details in the box provided. Attach additional documentation if necessary.

Step 5 – Section 5 – Your Signature (required)

  • Read all of the information on pages 3 and 4
  • Once read, understood and agreed, certify with the Service Member’s Signature, Social Security Number and the date in which the document has been signed and therefore, changed (mm/dd/yyyy)
  • You would then leave the remaining blocks blank and submit the form to the Personal Clerk for your Unit. The remaining blocks are reserved for the clerk and OSGLI
  • You may wish to request a copy before you leave so that you will have all of the pages needed to serve as proof of your changes.

 

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