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…NAME (LAST, FIRST, M.I.)
CERT.#
SOCIAL SECURITY #
EMPLOYEE HOME ADDRESS (STREET, CITY, STATE, ZIP)
Please indicate the coverage to which the beneficiary(ies) apply:
Basic Life
Voluntary Life
Group Permanent Life
AD&D
Accident
I AUTHORIZE Guardian or my employer to record and consider the individuals/instructions that I have named on this form…
https://www.wichita.edu/services/humanresources/Organizational_Development/New_Employee_Resources/NEO_Online/ICAA/Beneficiary_Designation_Form-Guardian.pdf