Medium
Forms Policy
- Digital signatures are not accepted by NDPERS.
- Completed forms must be submitted to NDPERS by fax, by mail, or as a scanned PDF.
- NDPERS does not accept picture files such as .jpeg, .jpg, .tif, or .png.
Select a form to download:
Enrollment and Designation of Beneficiary
- Life Insurance Enrollment/Change Form (SFN 53803)
- VOYA Life Insurance - Evidence of Insurability (EOI) and how to complete EOI - Do not complete section B. Do not send EOI directly to Voya.
- Life Insurance Designation of Beneficiary Form (SFN 53855)
Waiver of Premium
- Authorization for Release of Health-Related Information
- Attending Physician's Statement of Disability
- Waiver of Premium Disability Claim – Employer
- Waiver of Premium Disability Claim – Employee
Accelerated Benefit
- Accelerated Benefit Claim
- Accelerated Death Benefit - Physician's Statement
- Information regarding Accelerated Benefits
Conversion and Portability (Continuation)
- Life Conversion Information Request
- Term Life Coverage Continuation Request and portability rates
- Understand Conversion and Portability
Other general forms
- Authorization for Automatic Premium Deduction (SFN 50134)
- Authorization to Release Confidential Information (SFN 61324)
- Notice of Change for Name & Address (SFN 10766)