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 by attaching the form to the email

• Download the Census Data Request Form
• Complete the form below and upload the completed forms directly
  
• Please enable JavaScript in your browser to complete this form.

  Requester Name *

  First

  Last

  Type Census Requester

  Requester Phone Number

  Requester Email *

  Company Name *

  Census Type Requested *New Business Census Data RequestRenewal Census Data RequestUpdate / Mid-Year Census Data Request

  Upload Census Data File

  Submit

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:   bo*@*********ts.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.