Fillable Group Life Insurance (FEGLI) - Office of Personnel Management - opm
Assignment Federal Employees' Group Life Insurance (FEGLI) Program
*This is NOT a Designation of Beneficiary. Use SF 2823 to designate beneficiaries.
A. Information About the Insured (not the Assignee) (type or print)
Date of birth of Insured (mm/dd/yyyy) Name of Insured (Last, first, middle)
Note: Read instructions on the back of Part 2 before completing this form.
Social Security Number of Insured
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