VESO/Member Information

This page contains information applicable to both VESO and their members. Refer to the headings below for information specific to each.

VESO Information

Having a VESOLife insurance program is a great recruitment and retention benefit to fulfill the needs of Volunteer Emergency Service Organizations! Please contact your insurance broker to learn more about the VESOLife program and products and to determine if it’s the right fit for your organization. If you do not have a broker, send an email to vesoLife@nbtmang.com and we would be happy to align you with a VESOLife broker in your area.

Refer to the following information to request a quote or to obtain various forms applicable to VESO.

Request a Quote

Requesting a quote is easy! Email to vesoLife@nbtmang.com an Excel spreadsheet listing each member’s date of birth and whether they are male or female. Member’s names are not needed and should not be sent via unsecured email.

Forms

The following forms are in a PDF format and require Adobe Reader, a free software application that can be downloaded at adobe.com.

Application

This form is to be completed once you’ve received a quote and wish to enroll your organization into the VESOLife program.
Unlike other forms, send this completed application form with a premium check to the following address. Choose the form specific to the state noted.
VESOLife
66 S Broad St
Norwich, NY 13850

Application Form (CT) PDF
Application Form (DE, KS, MA, NC, NJ, NY, PA, RI, SC) PDF
Application Form (VA) PDF

Department Claim

This form is to be completed as soon as possible in order to advise us of the passing of a member of your group. Send the completed form to our Norwich address found at the bottom of the page. When available, also send a copy of the death certificate to the Norwich address.

Department Claim Form PDF


Member Information

Forms

The following forms are in a PDF format and require Adobe Reader, a free software application that can be downloaded at adobe.com.

Beneficiary Change Form

This form is to be completed if you wish to name more than one beneficiary under the certificate of insurance or if the present beneficiary designation(s) is to be replaced by a new designation(s). Send the completed form to our Norwich office address listed below.

Beneficiary Change Form PDF

Claimant Statement Form

This form is to be completed by the beneficiary designation(s) in order to claim benefits upon the Insured’s passing. Send the completed form to our Norwich office address listed below.

Claimant Statement Form PDF

Conversion Form

If eligible, this form is to be completed to convert the amount of our group life insurance, which was terminated or reduced, to an individual policy of life insurance. Send the completed form to our Norwich address listed below.

Conversion Form PDF

Enrollment Form

If eligible, this form is to be completed in order to enroll in your VESO program. Give the completed form to the designated employee in your organization. Choose the form specific to the state noted.

Enrollment Form (CT, NC) PDF
Enrollment Form (DE, KS, MA, NJ, NY, PA, RI, SC) PDF

The group life master policy (form no. GR-1982-1) contains exclusions, limitations, reductions in benefits and terms for maintaining coverage in force. Complete details can be found in the master policy. The descriptions provided herein are general in nature and are not a contract or a summary of the master policy. Coverages are subject to all master policy provisions. In the event of any conflict or inconsistency between the information contained within this website and the information contained in the master policy, the master policy will govern in all respects. For complete details, please contact the plan administrator.