Personal Life Insurance Employer Opt-Out Form

If you prefer that Church Benefits Board not communicate the employee-paid personal life insurance opportunity to your employees, please complete this form. Opt-out requests must be submitted by September 30, 2026 in order to remove employees from future communications pertaining to the 2027 Open Enrollment period.

Administator Name(Required)

First Last

Administrator Email(Required)

Enter Email Confirm Email

Church/Organization(Required)

Church/Organization Address(Required)

City State / Province / Region

Employer Acknowledgement #1:(Required)

By checking this box, I understand that I am forfeiting this optional employee-paid benefit for all eligible employees during the 2027 open enrollment period.

Employer Acknowledgement #2:(Required)

By checking this box, I understand that I am opting out of employee communications pertaining to open enrollment for personal life insurance in 2027.