Employee Enrollment Form Nationwide Life Insurance Company - iu17 2026

1. Click ‘Get Form’ to open the Employee Enrollment Form in the editor.
2. Begin with Section I, where you will enter your Employer Information. Fill in the Group Number, Employer Name, and Address details accurately.
3. 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.
4. In this section, also provide your Marital Status, Date of Birth, Social Security Number, and Employment details like Occupation and Hours Worked per Week.
5. 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.
6. 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.
7. Finally, review Sections V and VI for important notices and sign where indicated to confirm that all information is correct before submitting.

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