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SIGNATURE OF COMMANDING OFFICER 16D. DATE RECEIVED 16B. RANK TITLE OR GRADE FOR USE BY THE OFFICE OF LIFE INSURANCE SGLV 8285 SEP SIGNATURE OF OSGLI REPRESENTATIVE DATE APPROVE Supersedes and replaces SGLV 8285 APR 1994 Which will not be used. TO BE RETAINED IN MEMBER S OFFICIAL PERSONNEL FILE IMPORTANT Use this form to apply for 1. At this time the premium deduction should be made effective as of the date that the SGLV 8285 was submitted. Note I.

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