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 The Insured is: Place an "X" in the appropriate box. An employee A retiree A compensationer If MorePlease check both of these: Please check one: I am: the Insured an Assignee. See back of Part 2 for definitions. I have signed this form in the presence of the ... Less
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