Standard form 2817 2000-2026

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The document is a Life Insurance Election form for the Federal Employees' Group Life Insurance Program (FEGLI). It outlines the process for employees to elect or waive life insurance coverage, including Basic and optional insurance options. Employees are automatically covered for Basic insurance unless they choose to waive it. The form requires personal information, signatures for elected coverages, and provides instructions on how to complete it correctly. It also details the implications of waiving coverage and the conditions under which changes can be made.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in your identifying information in Section 2, including your name, employing department, Social Security Number, and contact details.
In Section 3, indicate whether you want Basic life insurance by signing and dating the appropriate box. Remember, if you do not sign for Basic, you cannot elect any optional insurance.
If you wish to select optional insurance (Options A, B, or C), proceed to Section 4. Mark the boxes for the options you want and specify the multiples where applicable.
If you choose not to have any life insurance coverage at all, sign and date Section 5 to waive all coverage.
Finally, review your completed form carefully for accuracy before submitting it through our platform to your employing office.

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Versions	Form popularity	Fillable & printable
2011	4.9 Satisfied (273 Votes)
2000	4.3 Satisfied (210 Votes)

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