Automatic Premium Conversion Waiver/Revocation of Waiver

Download PDF

Summary

Complete this form to waive your participation in automatic premium conversion, or to revoke a waiver of premium conversion that you filed previously.

If you would like to complete the form electronically, be sure to first download the form, complete using Acrobat Reader, and save.

Submit the completed form to your employer.

Note: ETF is unable to assist with Adobe Acrobat Reader technical or compatibility issues. If you need assistance, please visit Adobe’s help site.