DOWNLOAD APPLICATIONS > DECREASE YOUR COVERAGE
Reduce Amount of Coverage Form


* Certificate Number: 
* Full Name: 
 
* Phone Number: 
Email Address: 
 
* Address: 
 
City: 
State: 
Zip: 
 
* Current Amount of Coverage:   
Member    (Amount of Member Life Insurance)
 
Dependent  
(Amount of Spouse/DomesticPartner Life
Insurance Dependent coverage may
not be greater than half (50%) of
member coverage)
* Reduce Coverage Amount To:   
Member    (Amount of Member Life Insurance)
 
Dependent  
(Amount of Spouse/DomesticPartner Life
Insurance Dependent coverage may
not be greater than half (50%) of
member coverage)
 
* Effective Date of Reduction: 
Please note:
Our computer system does not permit us to make changes in advance of the current month. Your request will be processed in the month of the reduction request.
 
 Type the red numbers show, in the box below.
 Anti-Spam security feature   ...more info

Click the submit button above to submit the form online.
or print this form and fax it to (703) 790-4606 or mail it to:


WAEPA
7651 Leesburg Pike
Falls Church, Virginia 22043
* Required Information
- Top -