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Click ‘Get Form’ to open the SGLI Disability Extension Application in the editor.
Begin by filling out the Veteran Information section. Enter your first name, middle initial, last name, social security number, date of birth, gender, address, phone number, email address, date of separation, branch of service, and SGLI coverage amount.
In the Eligibility section, indicate whether the VA has rated you totally disabled based on individual unemployability. If yes, attach a complete copy of the VA rating decision document.
Complete the Veteran’s Impairment Statement if applicable. Check any conditions that apply and ensure to include supporting documents if necessary.
Fill out your Work Status by selecting your current work situation and providing any relevant details about your employment history since separation.
Sign and date the form in the Veteran’s Signature section. Remember to attach your most recent separation orders and Leave and Earnings Statement (LES).

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