For your convenience, all benefit forms are now available online. Each form comes in an easy to read and use pdf format.

The forms maybe completed in one of two ways:

  1. Print the form and complete by hand, OR;
  2. Complete the form on your computer, then print and sign.

Send completed forms via interoffice mail, postal service, or in person, to the County’s benefits staff representative listed in the Contact information of this website. FORMS MAY NOT BE ELECTRONICALLY TRANSMITTED

Life Insurance

Florida Combined Application

To elect new coverage through Florida Combined, print, complete, sign and return the original

Download Form

Change Form

To make changes to your existing term life policy, complete this form with the appropriate information.

Download Form

Evidence of Insurability Application

To elect new coverage only if late entrant or over $100,000

Download Form


County paid life insurance

Download Form

Download Life Certificate