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2017 LANGSTON LIFE AND LONGER DISABILITY ENROLLMENT/CHANGE FORM EMPLOYEE INFORMATION Please Print Campus Wide ID: Social Security #: Employee Name: Home Telephone: Married Single Divorced Gender:
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Who needs 2017 life and ltd?

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Individuals who wish to apply for life and long-term disability (ltd) insurance coverage for the year 2017.
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Life and ltd enroll-change is a form used to make changes to life insurance and long-term disability insurance coverage.
Employees who wish to make changes to their life insurance and long-term disability insurance coverage are required to file the life and ltd enroll-change form.
The life and ltd enroll-change form can be filled out online or in paper form, and requires the employee to provide information about the changes they wish to make to their insurance coverage.
The purpose of the life and ltd enroll-change form is to allow employees to make changes to their life insurance and long-term disability insurance coverage as needed.
The life and ltd enroll-change form typically requires information such as the employee's name, insurance policy number, and the changes they wish to make to their coverage.
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