Submit and Send, Fax or Email Completed Census Form.

Submit the completed Group Insurance Census Data Form by:

1. Download and complete the form using your computer and then press the SUBMIT button on the upper right hand corner to forward the document to RSI Benefits directly. Press OK on the pop-up window to send.
2. SUBMIT AND SEND

• Download the form, complete, save the file to your computer and print it and either fax or mail it to the address(s)  below.
• Census Data Request Form

Contact Us

You may call, fax or mail your Census Data Request Form to:

Robert Saunders
Employee Benefits Specialists
RSI Benefits
595 Orleans St., Suite 822-A
Beaumont, TX 77701

Phone: (409) 291-5851
Fax:     (832) 218-6479
Email:   bob@rsibenefits.com

Solutions

Insurance & Benefits for Employers & Employees.
Specializing in employee benefits and business
insurance with a focus on cost containment.
Serving TX, LA, OK & AR.