Forms
The following forms are available to be downloaded to your printer. Once completed, please return them to the Office of Benefits Administration. Please note that additional documentation is often required to accompany some forms. If you do not have Adobe Acrobat on your computer, you may down-load it from the ITS Web site.
Life and Accident Insurance
Change beneficiary, enroll or change amount of either Supplemental, Dependent Life or Accidental Death and Dismemberment Insurance.
Note: Increasing your Supplemental Life Insurance or enrolling in Dependent Life Insurance at the $50,000 level requires completion and submission of a Short Form Health Statement. If more information is required, a long Form Statement of Evidence of Insurability will be required and must be submitted directly to Prudential.
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