Employee Benefits life insurance forms

Please choose the form associated with the state in which your employer is headquartered. This may or may not coincide with your state of residence, however, please only use the form corresponding to the state in which your employer is headquartered. (Note: If a printable version is needed, please contact our Employee Benefits team at EOIprocessing@equitable.com and include the group or member certification number.)

Completed form must be signed, dated and returned to Equitable within 31 days of becoming eligible for the coverage.

• California
  

  • Online Web Form - Use this electronic submission form for a quicker response. (Google Chrome only)

• Florida

  • Online Web Form - Use this electronic submission form for a quicker response. (Google Chrome only)

• New York

  • Online Web Form - Use this electronic submission form for a quicker response. (Google Chrome only)

• North Dakota

  • Online Web Form - Use this electronic submission form for a quicker response. (Google Chrome only)

• South Dakota

  • Online Web Form - Use this electronic submission form for a quicker response. (Google Chrome only)

• All other states

  • Online Web Form - Use this electronic submission form for a quicker response. (Google Chrome only)