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Beneficiary receipt and release form

Form omb 3208-2026

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The document is a form for the Designation of Beneficiary under the Federal Employees' Group Life Insurance (FEGLI) Program. It outlines the necessary information required from the insured individual, including personal details and beneficiary designations. The form emphasizes the importance of following specific instructions, ensuring valid signatures, and understanding the implications of designating beneficiaries. It also provides guidance on how to cancel or change designations and includes privacy statements regarding the use of personal information.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out Section A, which requires information about the insured. Enter the date of birth, name, and Social Security number. Indicate whether the insured is an employee, retiree, or compensationer by placing an 'X' in the appropriate box.
Proceed to Section B to provide details about the beneficiary or beneficiaries. List each beneficiary's full name, Social Security number, address, relationship to the insured, and the percentage of benefits they will receive. Ensure that these percentages total 100%.
In Section C, complete your statement as either the insured or assignee. Check the appropriate boxes and provide your signature along with the date. Remember that two witnesses must sign this section as well.
Finally, review all sections for accuracy before submitting your completed form through our platform for processing.

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