Employee Enrollment Form Nationwide Life Insurance Company - iu17: Fill out & sign online

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Employee Enrollment Form Nationwide Life Insurance Company - iu17 with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the Employee Enrollment Form in the editor.
Begin with Section I, where you will enter your Employer Information. Fill in the Group Number, Employer Name, and Address details accurately.
Proceed to Section II for your Employee Information. Complete fields such as your Last Name, First Name, Gender, and contact details including Email and Phone numbers.
In this section, also provide your Marital Status, Date of Birth, Social Security Number, and Employment details like Occupation and Hours Worked per Week.
Move on to Section III to select your Coverage Elections. Carefully check the boxes corresponding to the coverage options you wish to elect or decline.
If applicable, complete Section IV by listing Beneficiaries for Life or AD&D benefits. Ensure that all information is accurate and totals equal 100% if percentages are specified.
Finally, review Sections V and VI for important notices and sign where indicated to confirm that all information is correct before submitting.

Start using our platform today for free to simplify your form completion process!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Contact us

How to get life insurance through employer?

Typically, the company pays for a base amount of coverage that may be a multiple of your annual salary, often one or two times that amount. Some employers offer a base amount of this type of life insurance at no cost to employees and may automatically enroll you on your first day of eligibility.

Is it worth getting life insurance through an employer?

Life insurance costs averaged $0.07 per hour worked among establishments with 500 workers or more and $0.04 per hour worked among establishments with 50-99 workers. Long-term disability insurance cost employers $0.05 per hour worked on average.