A signed illustration (please sign and return all pages).A voided check (only if you choose to pay monthly).Notice of Group Life Conversion (completed and signed by your employer).Within 31 days of your coverage termination date, you must complete and return the following documents along with your first premium payment:.Spouse/dependent information: name(s), date(s) of birth, address(es), Social Security number(s).The amount of Group Life coverage terminated or reduced.Date you received the Notice of Group Life Conversion form from your employer.Termination date or date benefits were reduced.We will ask you for the following information so we can send you the Group Life Conversion package containing the application, forms and your illustration. Tell us you want a Group Life Conversion application. Your employer must download and complete the Notice of Group Life Conversion.The cost of conversion coverage is different than your group coverage. If you opt to convert, you will be responsible for paying the Life premium. Can I continue my life insurance coverage if I retire or leave my job?
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