PDF
…Insurance available through your Employer, if
any. Designations are not valid unless signed, dated, and delivered to the Employer during your lifetime. See page 2 for further
information.
Primary - Full Name
Address
Soc. Sec. No.
Relationship
% of Benefit
Contingent - Full Name
Address
Soc. Sec. No.
Relationship
% of Benefit
Signature I wish…
https://www.wichita.edu/services/humanresources/Total_Rewards/docs/StandardVolADD.pdf