WAEPA - Download Applications

WAEPA Applications Library

Apply for membership and insurance
Apply for Associate Membership
Adjust your coverage
Apply for WAEPA Membership
Claims Forms

Click on the form name to fill out an application or change form online:

Complete all of the information on your selected form
Click the “continue” button at the bottom of the form
Once you‘ve completed any items you may have missed,
your form will be converted to a PDF file and saved onto your computer

Because each form requires a handwritten signature,
please print and mail your applications to:

WAEPA
433 Park Avenue
Falls Church, VA 22046

Apply for Membership and Insurance
Form Name	For:	Description:
Application for Membership and Life Insurance	Current and retired government employees Current and retired U.S. Postal Services (USPS) employees	Apply to become a WAEPA member and purchase life insurance for yourself and your dependents. [Get info on this]
Application for New Federal Hires Under Open Enrollment	First-time federal and USPS employees only	Apply for open enrollment life insurance within 180 days of your original hire date. [Get info on this]
Certify Your Domestic Partner	New WAEPA members Current WAEPA members adjusting their coverage	This form is required for domestic partners to apply for dependent coverage. [Get info on this] Domestic Partner Coverage is not available in Virginia. Domestic partners must complete this Domestic Partner Affidavit and include it with the WAEPA Membership & Life Insurance application or the Additional Coverage application
Apply for WAEPA Membership	WAEPA membership only	This application is to be used only if you are joining WAEPA in order that your spouse/domestic partner, or non-dependent children can join WAEPA as Associate Members and apply for their own WAEPA coverage.

[Back to top]

Apply for Associate Membership
Form Name	For:	Description:
Application for WAEPA Associate Membership and Life Insurance	Spouses, domestic partners, and adult non-dependent children, parents, parent-in-law of WAEPA members	Apply to join WAEPA and purchase life insurance as an Associate Member. [Get info on this]
Application to Join WAEPA Without Purchasing Life Insurance	WAEPA members	Use this form if you are joining WAEPA only so your spouse, domestic partner, or adult non-dependent child can join WAEPA as an Associate Member and purchase their own life insurance. [Get info on this]
Certify Your Domestic Partner	New WAEPA members Current WAEPA members adjusting their coverage Applicants For Associate Membership	This form is required for domestic partners to apply for associate membership. [Get info on this] Domestic Partner Coverage is not available in Virginia. Domestic partners must complete this Domestic Partner Affidavit and include it with the WAEPA Membership & Life Insurance application or the Additional Coverage application

[Back to top]

Adjust Your Coverage
Form Name	For:	Description:
Change Your Name	Current WAEPA members	Use this form to update the name on your policy.
Change Your Address		Use this form to update the address on your policy.
Change Your Beneficiary		Use this form to change your beneficiary.
Increase Your Coverage		Use this form to increase the amount of your current WAEPA coverage. If you add coverage for your domestic partner, please attach a domestic partner affidavit
Decrease Your Coverage		Use this form to reduce the amount of your current WAEPA coverage.

[Back to top]

Claims Forms
Form Name	Description:
Beneficiary Statement	Use this form, if you are a Beneficiary, Trustee or the party concerned with completing or filing a claim for a deceased WAEPA Member.
Dependent Group Life Benefits Proofs of Death	Use this form, if you are a Member who is completing or filing a claim for a deceased Dependent under your plan.
Multiple Beneficiary Statement	Use this form, if you are filing a claim for more than one beneficiary and you need to add their names to the claim you are filing.
Verification of Trust	Use this form, if a Trust was named as a beneficiary by the deceased Member.

[Back to top]

In accordance with state insurance regulations, the National Association of Insurance Commissioners has prepared a Life Insurance Buyer’s Guide for the State of Washington only. The National Association of Insurance Commissioners is an association of state insurance regulatory officials. This association helps the various insurance departments to coordinate insurance laws for the benefit of all consumers. This guide does not endorse any company or policy. Reprinted by Life Insurance Company of North America.

About WAEPA online forms: The Online WAEPA Forms tool will create a document
in the Adobe Acrobat PDF file format. Most modern web browsers have built-in
Adobe Acrobat PDF file support/viewers, and will display the forms correctly.

About Adobe Acrobat Reader: Adobe PDF Reader is required to use these forms online. If you have an older web browser or are having difficulties viewing the PDF file, try downloading and installing the latest Adobe Acrobat PDF viewer (it's free).

About your browser’s security: The Online WAEPA Forms should work without any problem using a modern web browser and the default settings. However if you have changed the security settings to restrict dynamic content (JavaScript, ASP, etc), the forms will not work. For the Online WAEPA Forms to work correctly, your browser security settings must allow dynamic content (i.e., let scripts run).

If you are still having problems using the forms, there is an alternative "Print Only"
version of each form that does not provide any of the form validation, error checking, required field checking, or help messages. Look at the bottom of the form page
for the link to "Print Only" version of the form.

ONLINE FORMS:

Request forms
by mail

INFORMATION:

About WAEPA
online forms

About Adobe
Acrobat Reader

About Your
Browser's Security