Used to claim benefits for the death of family members covered by FEGLI Option C coverage.
Electronic Copies:
NOTE: This electronic form requires Adobe Acrobat 5.0 or above. |
To use Adobe Acrobat forms you need the commercial Acrobat software or the free downloadable Acrobat Reader. You can fill in this form on your computer screen before you print it.
 
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Employees:
Request a paper copy of this form from your servicing Human Resources Office.Annuitants:
- Call toll free 1-888-767-6738 (202-606-0500 in the DC Area), or
- Send an email to retire@opm.gov, giving the number of the form that you need and your mailing address, or
- Request a copy from a local Federal agency Human Relations Office.
Agency field offices should order through their headquarters office and NOT directly from OFEGLI.Agency headquarters insurance officers order FE forms directly from OFEGLI. OFEGLI accepts orders by fax and mail only - no telephone orders. The fax number is 201-395-7950 - Attention: Forms Ordering Desk. The mailing address is Office of Federal Employees' Group Life Insurance, Attention: Forms Ordering Desk, P. O. Box 2627, Jersey City, NJ 07303-2627. OFEGLI will need the form number, the quantity, the shipping address and the point of contact, in case of questions.
Agency Insurance officers may request that the forms be sent to major field installations of the agency. The quantity must be sizable (minimum order of 500 forms) to each installation. The complete address and contact information for each installation must be included.
Please note that if you want smaller quantities of the form you can download the Adobe Acrobat PDF version from this page and print them locally.