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The Lincoln National Life Insurance Company at one of the following:

The Lincoln National Life Insurance Company at one of the following: 2026

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The document is an Evidence of Insurability Cover Sheet for The Lincoln National Life Insurance Company, intended for employees of the West Virginia University Research Corporation. It outlines the process for submitting completed forms via mail, fax, or email, and includes sections for group and employee information, coverage details, medical history questions, and authorization for information release. The document emphasizes the importance of accurate information and includes fraud warnings specific to various states.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Group Information section. Enter the Group Name, Group ID, and Billing Division/Location clearly.
Proceed to the Employee Information section. Complete all fields including your name, Social Security Number, date of birth, and contact details.
If applicable, fill out the Spouse Information section with similar details as required for the employee.
In the Plan(s) Applied for section, indicate the coverage amounts you are applying for under Basic and Optional/Voluntary Coverage(s).
Complete the Medical Information sections as necessary based on your health status and history. Be thorough to avoid delays.
Finally, review all entries for accuracy before signing and dating the form at the bottom.

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