VFIS is pleased to provide a multiuse beneficiary form for use by emergency service organizations (ESOs). It was designed for the ESO to use this form for any VFIS program or insurance policy where the individual member/employee has the opportunity to designate their own beneficiary.
To use this form:
- Download the form to a computer or network.
- In the section entitled Policyholder Name and Policy Number:
- Click on the box. This will generate a drop-down menu listing the most common insurance policy types. Click the appropriate policy type.
- Type the Policyholder Name (generally the name of the ESO).
- Complete the policy number if known.
- If a self-insured death benefit or a policy or program is not listed on the drop-down menu, click Other and add the name of the program/policy.
- Print a sufficient number of forms for each organization.
- Distribute the forms and have the insured member/employee complete the form as indicated.
- Have the individual sign and date the form.
- Please note if a member/employee does not want the same beneficiary to receive the proceeds of all policies/programs, the appropriate block should not be checked and an additional form
should be completed to identify the beneficiary.
Click here to download the form from our website.