Directions To Personnel Clerks Of The Uniformed Services 

1. Complete all appropriate items on this form. All entries except the signature and those 

requested to be in the service member’s own handwriting, must be typed or printed in ink. 

2. Include the name, address, and social security number (if available) of the beneficiary(ies), 

and the relationship of the beneficiary(ies) to the service member (e.g. father, sister). 

3. If a service member wants to designate a beneficiary other than would be normal under his 

or her family circumstances, see “Unclear or Unusual Beneficiary Designations” (section 

6.03) in the Servicemembers’ Group Life Insurance Handbook, Handbook 29-75-1 

(www.insurance.va.gov). 

4. A representative of the Uniformed Services must sign his or her name below that of the 

service member to indicate that he/she received the form from the member (whether in 

person, by mail or electronically) and should include the date he/she received it. 

5. This form, properly completed, is authority to a payroll office to initiate or change the 

deductions for insurance premiums if the amount of insurance is changed or cancelled. 

6. If this form is being used to decline SGLI coverage, inform the service member that this 

action will mean that he/she will no longer have Family SGLI coverage - both spousal 

coverage and dependent child coverage – or Traumatic Injury Protection (TSGLI). Have 

the service member complete SGLV 8286A and take action to end payment of Family 

spousal premiums. No additional forms need to be completed to end payment of TSGLI 

premiums. 

7. Inform the service member that if he/she is married or gets married after completing this 

form, his/her spouse is automatically covered under Family SGLI and premiums are due for 

this coverage and will be deducted from his/her pay if his/her spouse is registered in 

DEERS. If his/her spouse is not registered in DEERS, premiums cannot be deducted and 

the member will owe a debt for unpaid premiums. 

8. Inform the service member that if he/she has questions about this form, he/she may obtain 

the advice of a military attorney at no expense to the service member. 

9. After the form is completed in its entirety, you should: 

• File a copy of pages 2 and 4 in the member’s official personnel file. 

• Provide a copy of pages 2-5 to the service member. 

• Provide a copy of pages 2 and 4 to the Active or Reserve component of the 

Uniformed Services. 

Remember: If this form is used to decline SGLI coverage and the service member has 

Spousal Family SGLI coverage, you should take action to discontinue payment of spousal 

Family SGLI premiums. 

Note: Please do NOT send any of the forms or copies to the Office of Servicemembers’ 

 Group Life Insurance or to the Department of Veterans Affairs. 

SGLV 8286, May 2009 p. 1 
Please read the instructions before completing this form. 

Servicemembers’ Group Life Insurance Election and Certificate 

Use this form to: (check all that apply) 

 Name or update your beneficiary 

 Reduce the amount of your insurance coverage 

 Decline insurance coverage

Important: This form is for use by Active Duty and Reserve members. This form does 

not apply to and cannot be used for any other Government Life Insurance. 

Last name First name Middle name Rank, title or grade Social Security Number 

Branch of Service (Do not 

abbreviate) 

Current Duty Location 

Amount of Insurance 

By law, you are automatically insured for $400,000. If you want $400,000 of insurance, skip to Beneficiary(ies) and Payment Options. If 

you want less than $400,000 of insurance, please check the appropriate block below and write the amount desired and your initials. 

Coverage is available in increments of $50,000. If you do not want any insurance*, check the appropriate block below and write (in your 

own handwriting), “I do not want insurance at this time.” 

Declining SGLI coverage also cancels all family coverage and traumatic injury protection under the SGLI program.

 I want coverage in the amount of $_______________________ Your initials________________ 

 _______________________________________________________________________________ 

(Write “I do not want Insurance at this time.”) 

*Note: Reduced or refused insurance can only be restored by completing form SGLV 8285 with proof of good health and compliance with other requirements. Reduced or refused

insurance will also affect the amount of Veterans’ Group Life Insurance you can convert to upon separation from service. 

Beneficiary(ies) and Payment Options 

I designate the following beneficiary(ies) to receive payment of my insurance proceeds. I understand that the principal beneficiary(ies) will receive payment 

upon my death. If all principal beneficiaries predecease me, the insurance will be paid to the contingent beneficiary(ies).

Complete Name (first, middle, last) and 

Address of each beneficiary 

Social Security 

Number 

(if known) 

Relationship 

to you 

Share to each 

beneficiary 

(Use %, $ amounts or fractions)

Payment Option 

(Lump sum or 36 equal monthly 

payments)

Principal

1. 

2. 

3. 

4. 

 Additional Principals on page 4 (check if 

applicable) 

Contingent 

1. 

2. 

3. 

4. 

 Additional Contingents on page 4 (check if 

applicable)

I HAVE READ AND UNDERSTAND the instructions on pages 2 and 3 of this form. I ALSO UNDERSTAND that: 

• This form cancels any prior beneficiary or payment instructions.

• The proceeds will be paid to beneficiaries as stated in #6 on page 3 of this form, unless otherwise stated above. 

• If I have legal questions about this form, I may consult with a military attorney at no expense to me. 

• I cannot have combined SGLI and VGLI coverages at the same time for more than $400,000. 

• If I am married or If I get married after completing this form, my spouse is automatically covered under Family SGLI for which premiums will be 

deducted from my pay, unless I decline Family SGLI coverage by completing SGLV 8286A. For Family SGLI premium deductions, my spouse MUST

be registered in DEERS. Failure to do so will result in debts owed for unpaid premiums. 

SIGN HERE IN INK 3⁄4_______________________________________________ Date: ______________ 

 (Your signature. Do not print.)

Do not write in space below. For official use only. 

RECEIVED BY: RANK, TITLE OR GRADE ORGANIZATION DATE RECEIVED 

SGLV 8286, May 2009 Copy 1 = Member’s Official Personnel File p. 2 Copy 2 - To Member
 Copy 3 - To Active or Reserve Component of Uniformed Service 

ers' e provisions 

s, and title 38 Code of Federal Regulations. 

 must ple re med Servic r for this designation to be valid. 

overage 

your spouse is automatically covered under Family SGLI and premiums will be 

our pay, unless you decline Family SGLI coverage by completing SGLV 8286A. You must register your spouse in DEERS for 

Family SGLI premiums to be deducted from your pay. use in DEERS, premiums cannot be deducted. This will 

y may be required to perform active duty or active duty for training and each year will 

ited 

rance 

within 120 days of by contacting 

the Office of Ser

her giv names Mary ad of Mrs

c. A hanged automatic event occurring after you complete t marr age

beneficiary cannot be changed by, and is not affected by documents such as a divorce de

want to name more than four principal contingent beneficiaries, list the additional beneficiaries on the Beneficiary ntinuation Form 

ocks on page 2, indicating that you have done so. The Benefic ry Continuation 

Form (page 5) should then be attached to page 2 of the 8286. 

. If you name minor children as beneficiaries, the insurance will be paid to the court-appointed guardian of the children's estat

You can establish a trust for the benefit of the children and name the trust as beneficiary. A trust names a trustee of your choice to be legally 

responsible for administering the insurance proceeds for the children. Naming a trust as a beneficiary on this form does NOT create a trust. Before 

ing a trust as beneficiary, you should consult a military attorney for assistance. 

Social Security Number - Do not delay completing this form if you d not have a beneficiar s Social Security Number. The Social Security 

, but is not required. 

3. Shares to each Beneficiary - If you name more than one beneficiary, the sum of the shares must equal 100% or the full dollar amount of your 

 

Directions To Service Member

What You Should Know 

This insurance is granted under the Servicememb Group Life Insurance provisions of title 38, United States Code, and is subject to th

of that title and its amendment

This form be correctly com ted, signed and ceived by your Unifor e before your death in orde

Marriage and SGLI C

If you are married or you get married after completing this form, 

deducted from y

If you do not register your spo

result you owing a debt for back premiums.

Periods of Coverage 

SGLI is in effect throughout the period of full-time active duty or active duty for training. Coverage is also in effect on a full-time basis for 

reservists who are assigned to a unit or position in which the

be scheduled to perform at least 12 periods of inactive duty training that is creditable for retirement purposes under Chapter 1223 of title 10, Un

States Code. SGLI coverage continues for 120 days following separation or release. You may convert your SGLI to Veterans’ Group Life Insu

 of separation without proof of good health, or within one year and 120 days separation with proof of good health 

vicemembers’ Group Life Insurance (see below). 

Instructions On Completing This Form (Type or print in ink all items except where otherwise noted.) 

1. Naming Beneficiaries 

a. A new SGLV-8286 must be completed to change your beneficiary. You may name anyone as beneficiary without his/her consent. However, your

spouse will be notified if you reduce coverage or name a beneficiary other than your spouse. 

b. If the beneficiary is a married woman, use 

named beneficiary will NOT be c

en first and middle

ally by any

. For example, use Lisa Smith, inste . John Smith. 

his form (e.g. i

cree or will. 

, divorce, etc.). our Y

, any other

d. If you or Co

(page 5) and check the block under the principal or contingent bl ia

e

f. 

e.

nam

2. 

Number helps us to locate the beneficiary

o y'

insurance. 

Example: mother $200,000 50% 1/2 

father $200,000 or 50% or 1/2

Total $400,000 100% 1

4. Payment Option - You may choose whether you want the beneficiary to receive payment in one lump sum or in 36 equal monthly payments by 

ment Option. If you choose 36 payments, the beneficiary cannot choose to receive a lump sum 

payment. If you want the beneficiary to have a choice at the time of payment, write "lump sum" or leave the block blank. 

Provisions For Payment Of Insurance 

a. If you name more than one principal beneficiary and one or more predeceases you, the share(s) will be divided equally among the remaining 

no surviving principal beneficiaries, the proceeds will be divided among the contingent 

beneficiaries. 

neficiaries, or if you indicate that payment should be made b

W

U

These claim

SGLV 8286, May 2009 To Member p. 3

writing "lump sum" or "36" in the column labeled Pay

5. 

principal beneficiaries, unless otherwise stated. If there are 

b. If you do not name a beneficiary, or if there are no surviving be

will be paid in the following order: 

y law, the proceeds

 1. Widow or widower 

2. Children in equal shares (the share of any deceased child will be distributed equally among the descendants of that child)

 3. Parent(s) in equal shares or all to surviving parent 

 4. A duly appointed executor or administrator of your estate 

 5. Other next of kin 

hat Your Beneficiaries Should Know 

pon your death, the Casualty Assistance Office for your branch of service will assist your beneficiary in filing a claim for the insurance proceeds. 

s are su ted to the bmit Office of Servicemembers' Group Life Insurance, 80 Livingston Avenue, Roseland, NJ 07068-1733. Your 

beneficiary may also call 1-800-419-1473 for claim information. 
Please read the instructions before completing this form. 

Servicemembers’ Group Life Insurance Election and Certificate 

Beneficiary Continuation 

Instructions: ants to name more beneficiaries than the number of beneficiary spaces 

p

This page is to be used ONLY when the service member w

rovided on page 2. If this page is completed, it should be copied and distributed together with page 2 of this form. 

Member Information 

Last name First name Middle name Rank, title or grade Social Security Number 

Beneficiary(ies) and Payment Options 

In of my 

in

in

 addition to the beneficiaries I have named on page 2 of this form (SGLV 8286), I also designate the following beneficiary(ies) to receive payment

surance proceeds. I understand that the principal beneficiary(ies) will receive payment upon my death. If all principal beneficiaries predecease me, the 

surance will be paid to the contingent beneficiary(ies).

Complete Name (first, middle, last) and 

Address of each beneficiary 

Social Security 

Number 

(if known) 

Relationship 

to you 

Share to each 

beneficiary 

(Use %, $ amounts or 

Payment Option 

(Lump sum or 36 

equal monthly 

payments) fractions)

Principal 

5. 

6. 

7.

8.

9. 

10. 

Contingent 

5. 

6. 

7. 

8. 

9. 

10. 

I 

This is a continuation of my beneficiary designation on page 2 of this form, Servicemembers’ Group Life Insurance Election and Certificate.

T pro eficiaries as stated in #6 on page 3 of the SGLV-8286, unless otherwise stated above. 

S N _____________________ Date: ______________ 

int.)

HAVE READ AND UNDERSTAND the instructions on pages 2 and 3 of this form. I ALSO UNDERSTAND that: 

he ceeds will be paid to ben

IG HERE IN INK 3⁄4__________________________

 (Your signature. Do not pr

Do not write in space below. For official use only. 

RECEIVED BY: RANK, TITLE OR GRADE ORGANIZATION DATE RECEIVED 

SGLV 8286, May 2009 Copy 1 - Member’s Official Personnel File 

 Copy 2 - To Member 

 Copy 3 - To Active or Reserve Component of 

 

 p. 4 

 Uniformed Service 
TSGLI provides all service members wh have 

SGLI with traumatic injury protection. TSGLI 

provides for payment of up to $100,000 to 

service members who incur a qualifying loss as 

the result of a traumatic injury (on or off duty). 

TSGLI payments are designed to help 

traumatically injured service members d their 

families with financial burdens associat with 

recovering from a severe injury (such as travel, 

mporary housing, and loss of income) 

o

an

ed

te .

SGLI Traumatic Injury Protection Program (TSGLI)

SGLI Disability Extension 

Veterans’ Group Life Insurance (VGLI)

Service-Disabled Veterans Insurance (S-DVI)

Veterans’ Mortgage Life Insurance (VMLI)

What You Need To Know About Your Life Insurance Benefits 

For More Information 

For more info io u e fits, vi t rmat n abo t thes bene si www. suran e.va.g in c ov. You can also call us toll-free at

the following numbers: 

SGLI, SGLI Disability Extension, VGLI: 1-800-419-1473 S-DVI, VMLI: 1-800-669-8477

Family SGLI

Servicemembers’ Group Life Insurance (SGLI)

Keep This Paper With Your Records 

to $90,000 to severely disabled veterans and 

 housing grant from VA. It is 

designed to pay off some or all of the home 

ce 

You are eligible for a varie erving in the military and after 

crem

$50, in effect for 

days after discharge. Members who have S

tically have TSGLI. 

Family SGLI provides automatic coverage to the 

spouses and dependent children of service 

members who have SGLI coverage. Spouses are 

insured for $100,000 or the amount of the 

member’s coverage, whichever is less. 

Dependent children are automatically covered for 

$10,000 at no cost to the service member. 

Service members must register their spouse in 

DEERS to ensure proper premiums are deducted. 

VMLI provides mortgage life insurance of up 

service members who have received a 

specially adapted

mortgages of disabled veterans and servi

members in the event of their death. 

ty of life insurance benefits while s

discharge. It is important that you understand these benefits so you can make informed 

decisions about providing for the financial security of your loved ones. 

Upon enlistment, service members automatically 

have the maximum $400,000 of SGLI coverage. 

Service members can decline or elect lesser 

amounts of coverage in writing in in

000. SGLI coverage stays

ents of 

120 

GLI 

automa

Members can decline or elect less coverage, but 

not registering a spouse in DEERS is not the 

equivalent of declining spousal coverage. 

The SGLI Disability Extension allows service

members who are totally disabled at time of

discharge to retain the SGLI coverage they 

had in service up to

s. The servi r must ap

the Office of Servicemembers’ Group L

Insurance for this extension.

at no cost for two 

year ce membe ply to 

ife 

VGLI allows service members to convert 

their SGLI coverage to lifetime renewable 

term insurance. The amount of VGLI 

coverage cannot exceed the amount of 

SGLI coverage the member has at 

discharge. Members can apply within 120 

days of discharge without proof of good 

health, and for one year after that with 

proof of good health.

S-DVI provi es up to $10,000 in overage to 

disabled veterans who have received a new 

VA disability rating. Veterans ha e two years 

from the date VA notifies them of their rating 

to apply for this coverage. Veterans who are 

totally disabled can apply to have their 

premiums waived. If approved for waiver, 

the veteran can apply for an add onal 

$20,000 in coverage. 

SGLV 8286 To Member p. 5

d c

v

iti

W SE HILE IN RVICE AFTER DISCHARGE