ELECTION, DECLINATION, OR WAIVER OF LIFE INSURANCE COVERAGE - CARANCI, JOHN C.

• Document Type: FOIA
• Keywords: PERSONNEL FILES
• Keywords: CARANCI JOHN
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0001411722
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 1
• Document Creation Date: June 22, 2015
• Document Release Date: December 31, 2008
• Case Number: F-2007-00327
• Publication Date: February 27, 1968

APPROVED FOR RELEASE^DATE:
10-Nov-20084; Z&*VION, DEC DR`-WAIVER
OF LIF ,INS ANC C VEIf` GE
ORAL EMPLOYEES GROUP UFU INSURANCE P,
TO; COMPLETE THIS FORM-
_ ?':mod },...-2. _. .a. -.
., FO$J,QW THESE GENERAL INSTRUCTIONS
Read the back of thO Wupiicate" carefully' befare you f tt lit the firm,
Fill in BOTH C?PIES of the form Type oruae in14
a
-Do npt detach any D~ " - '
(A
SI III= IN THE IDENTIFYING INFQRMAT1ON1$EL.QW ;{p CCar+t-'pnrtt or iyPe :
V, t
tiAA9E : flesh . (fir tmi ?) 1*4 Of B(ma 4 dad. yei,
/V r
l.0CATIOt0 (City Stat41 ZIP'Code):
MARK AN "X" IN ONE OF THE BOXES BELOW,-(di NOT mark more ante
WANE UQQTt'i_
tlptionaF. and
i :xegular
Msuvanee
I4I~trlc , here r a-+sa~,"
i You
Mirk;; h+dr --~'
If you-
DO NOT, WANT
OPTIONAL but
do Savant
regular
insurance
12
. ?IMPORTT,A?1T
AGENCY INSTRU IiQN .
ON BAkk cP 'OREG1B i
SQCIIAL