Group Life Insurance Forms
Forms may be downloaded by clicking the download links below. To request a hardcopy form, please send an email request via the link in the “Request form via email” column next to the form name. For all other inquiries, please contact MainePERS directly.
To use these forms you will need Adobe Reader®. Information on completing forms with Reader®. Forms using Adobe Reader can be printed, but cannot be saved electronically.
Digital Signature Forms through DocuSign: A number of forms are available for completion online with your digital signature and these forms are identified in the “Digital Signature Forms” column next to the form name. The form is completed, signed, and submitted electronically. You will have an option to save an electronic copy of any form you opt to fill out electronically and sign digitally.
Once you select the document, step-by-step directions are available within the DocuSign application.
Click here for more information on digital signatures
Digital Signature:
A digital signature means a computer-created electronic signature that is:
- unique to the person using it;
- intended by the person using it to have the same force and effect as the use of a manual signature;
- capable of verification;
- under the sole control of the person using it; and
- linked to data in such a manner that it is invalidated if changes are made to the data.
Digital signatures require creation by specialized software platforms.
| Form Number | Form Name | Download form as PDF | Request form via email | Digital Signature Forms |
|---|---|---|---|---|
| CL-0893 | Affidavit for Small Estates | Download CL-0893 | Request CL-0893 | |
| GI-0874 | Request for Basic and/or Additional Insurance Coverage Requiring Evidence of Insurability | Download GI-0874 | Request GI-0874 | Download DocuSign Form GI-0874 |
| GI-0880 | Adding Dependent Insurance within 31 days of Event | Download GI-0880 | Request GI-0880 | |
| GI-0881 | Cancellation/Reduction in Coverage | Download GI-0881 | Request GI-0881 | |
| GI-0912 | Designation of Beneficiary - Group Life Insurance (Individuals completing this form might also consider completing the Pension Beneficiary Designation for Pre-Retirement Death Benefits form.) | Download GI-0912 | Request GI-0912 | Download DocuSign Form GI-0912 |
| GI-0920 | Third-Party Designation | Download GI-0920 | n/a |