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First-Time Insurance Census

Final Census

Please complete all fields to submit your census!

Funeral Home

Does your funeral home currently offer insurance? *

Yes

No

Employee

Dependent of

Employee

empHeadId

Full Name

Dependent relation

Email

Sex

Date of Birth

Zip Code

Is this person currently on your insurance?

Will this employee be included on The Group's insurance?

Yes

No, this employee is declining or not offered the insurance.

Does this employee have dependents who will be covered?

Yes

No

Are there more covered dependents of the employee? *

Yes

No

funeralHome

What coverages does this person want?

Do you have other Full-Time employees? *

Yes

No

Please ensure all fields are complete before submitting!

Your census has been recorded! Thank you.

Contact Us

503 National Drive,
Maryville, TN, 37804

Tel: 865-977-0027
Email: info@tifg.net

© 2024 by TIFG. All rights reserved.

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