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GROUP COVERAGE CHANGE FORM For GWL Head Office Use Only GWL Certificate Number Please print clearly and complete both sides of this form in INK. Sections 1 2 are to be completed by the plan administrator and sections 3 through 11 are to be completed by the plan member for applicable changes. The plan administrator should keep a copy of the completed form for their records and send the original to The Great-West Life Assurance Company. Plan Member Name Change From CONTINUE ON REVERSE SIDE...
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How to fill out Great West Life Group:

01
Gather all necessary personal information such as full name, date of birth, and contact details.
02
Review the provided enrollment form and ensure all sections are completed accurately.
03
Provide information regarding any dependents that need to be included in the group coverage.
04
Indicate the desired coverage options and benefits for the group plan.
05
If applicable, provide any additional information or documentation required by Great West Life.
06
Double-check all entries for accuracy and completeness before submitting the form.

Who needs Great West Life Group:

01
Employees of companies or organizations that offer group benefits.
02
Individuals who want to secure group insurance coverage for themselves and their dependents.
03
Companies or organizations looking to provide comprehensive insurance options for their employees.

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Great West Life Group is a financial services company that offers insurance, investment, and retirement solutions to individuals and businesses.
Employers who provide Great West Life Group insurance to their employees are required to file the necessary forms and documents.
To fill out Great West Life Group forms, you will need to provide information about the insured individuals, their beneficiaries, and relevant policy details. You can do this online or by submitting physical forms.
The purpose of Great West Life Group is to provide insurance coverage and financial protection to individuals and businesses, helping them secure their future and manage risks.
Great West Life Group requires information about the insured individuals, such as their names, dates of birth, and coverage details. It may also require beneficiary information and policy numbers.
The deadline to file Great West Life Group in 2023 may vary depending on your specific policy and employer requirements. It is best to consult with your employer or Great West Life Group directly for the exact deadline.
The penalty for the late filing of Great West Life Group may vary depending on your jurisdiction and specific circumstances. It is advisable to consult with Great West Life Group or a legal professional for information regarding penalties.
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