life insurance beneficiary designation form

Published by on May 29, 2021

Who must sign this form: Policyowner(s) – Required signature . Life Insurance Beneficiary Designation – State Employees, State Police, Judges. After you finish a section, click on "Back to Top" to navigate to a new section. Name of Insured Most life insurance policies have a default order of payment if you do not name a beneficiary. Employees must verify beneficiary information or change/update a beneficiary online using MBOS! Enrollment/Change Form - This form is for enrolling in, canceling, or changing your election of health, basic life, optional life, and long term disability insurance. Provide the requested information including the beneficiary type (primary or contingent) and the % proceeds for each. Voluntary Term Life Insurance, Life Insurance Company of North America - Policy No. Challenging a Life Insurance Beneficiary Designation because there was a Forged Life Insurance Beneficiary Change. Rights and Settlement Option Request (Form 4113). The insurance company will not accept any designation using the words "Per Stirpes." Employer Name/Group Policyholder Name . Shares of all primary beneficiaries must total 10 . DESIGNATION OF BENEFICIARY - GOVERNMENT LIFE INSURANCE SECTION I - VETERAN'S IDENTIFYING INFORMATION€ (All information requested in this section is required) INSTRUCTIONS FOR COMPLETING THIS FORM . The Nationwide Retirement Institute is a division of NISC. Beneficiary Change Request. Assets such as life insurance, annuities and retirement accounts (401(k)s, IRAs, 403bs and similar accounts) all pass by beneficiary designation. 3206-0136 Federal Employees Federal Employees' Group Life Insurance (FEGLI) Program Important: Group Life Insurance (DO NOT erase or cross-out. MUST. beneficiary(ies) as indicated on this form to receive the proceeds of the basic and optional group life and accidental death and dismemberment insurance policies administered by VRS if I am covered under those policies, and to receive the accumulated Child Rider (one designation applies for all children under a child rider) Term Life Insurance Rider. and Group Accidental Death Insurance payable at my death. PDF version (53k) 403(b) Beneficiary Change Use this form for a change of Beneficiary and Spousal Consent for ERISA or Non-ERISA 403(b). Note: These forms are in PDF format. Beneficiary Form Group Term Life Insurance 100-12711 - Important Note: This Beneficiary Designation cancels any prior beneficiary designation and shall be effective on the date received by the Company Policyholder: Individual Covered Person SSN# and DOB: Phone# Street Address (please include apartment # as applicable) City State Zip Section 1: General information For your convenience, a FAQ regarding beneficiary designations is available on our website at www.assurantemployeebenefits.com. SGLV 8721 Beneficiary Designation Form (VGLI) updated November 2012. The company indicated in this section is referred to as "the Company." Please print in blue/black ink, or type beneficiary information below. The Thus, when the account owner or the insured in the case of life insurance dies, the asset passes directly to the beneficiaries named in the beneficiary designation form … (fillable) 29-353 Application for Reinstatement(Non-medical, Comparative Health) If this Designation of Beneficiary refers only to a Group Life Insurance Policy and if I am also insured for Supplemental and/or Group Accidental Death coverage, this designation shall apply to those coverages. Group Life Insurance Beneficiary Designation Commonly Asked Questions . At the top of the form, fill in your personal information. SECTION 1: Insured information . • To name additional beneficiaries, attach a separate page. Learn the basics. If at least one of the designated beneficiaries survives the decedent, the life insurance proceeds pass directly to the beneficiary outside of probate. Beneficiaries may be named as: 1. Both USAA Life Insurance Company and USAA Life Insurance Company of New York are referred to as USAA Life in this form. Used when the beneficiary designation has a 'per stirpes' designation and a named or unnamed beneficiary is predeceased. Secondary Coverage (spouse rider, joint life/annuity contract) Section 2 - Primary and Contingent Beneficiary. Life and annuity products are issued by Nationwide Life Insurance Company or Nationwide Life and Annuity Insurance Company, Columbus, Ohio. Prudential Retirement Insurance and Annuity Company - California COA # 08003. Policy Number Insuring the Life of: The following designation cancels all prior beneficiary and settlement designations under the above-numbered policy. 3/21. RETIREE LIFE INSURANCE Beneficiary designations become effective upon completion of this form. 2. However, it is a good practice to periodically take the time to review these forms, especially when you have a significant change in your life … The entire purpose of getting life insurance is to help take care of people you love – your beneficiaries – if you die unexpectedly. Issuer: John Hancock Life Insurance Company (U.S.A.), Lansing, MI (not licensed in New York). MUST. (Life Insurance Only) - Select One - Beneficiary designation will apply to the option selected. (fillable) 29-352 Application for Reinstatement: Use this form to reinstate your insurance policy if it has lapsed for more than 6 months. Transamerica Premier Life Insurance Company Fax Number 1-800-235-4782 Administrative Office located at: 4333 Edgewood Rd. Pruco Life Insurance Company, an Arizona company - California COA # 3637. If the annuitant dies before the change is recorded, the change will not affect payments already paid. Save a copy to your computer, fill in the information, and send the completed form to us. Select the class for each beneficiary. Life insurance benefits will be paid according to the standard order of beneficiary as follows: to the surviving spouse/domestic partner, if none, then Metropolitan Life Insurance Company Page 3 of 3 GR-TR-BENE-MET2-32BJ (04/13) Fs SECTION III - Signature Check if you are completing and signing this form as agent for the employee under a valid Power of Attorney. Do not erase or attempt to make corrections; use a new form. COMPLETING YOUR BENEFICIARY DESIGNATION FORM 1. Name Change Request. Group Term Life Insurance Beneficiary Designation • This form MUST be signed before you return it. We would like to show you a description here but the site won’t allow us. Beneficiary Form for MetLife Growth and Income Annuity (PDF) . SI . P.O. Click on a section to navigate to or scroll down to each section. This designation invalidates all previous Designations of I request any policy provision which requires the policy be endorsed to change the beneficiary be waived. If a minor becomes the beneficiary of a life insurance payout, then the decision regarding what to do with the proceeds is in the hands of the probate court. Individual Life Insurance Owner initial here. To change your beneficiary, access and complete Lincoln’s change beneficiaries form or speak with one of our helpful customer service agents. State or policy life insurance beneficiary rules − Your state or the insurance carrier may restrict who you can name as a beneficiary. For many individual policies, the death benefit will be paid to the owner of the policy if they are different than the insured person and still alive, otherwise it will be paid to the owner's estate. CalPERS and departmental beneficiary designations do not apply to life insurance benefits payable under the Metropolitan Life Insurance (MetLife) program. change a Beneficiary designation. Update your beneficiaries Designate, change or update beneficiaries for your employer sponsored retirement plan or IRA, your personal annuities, your mutual fund accounts, or your life insurance. The Beneficiary Designation (ET-2320) form is divided into parts with details to help you understand the information. Read instructions on the Back of Part 2 before completing this form. Name o f Emp loyer Group Pol icy No . Other Required Signature Please do not send in your policy with this request. BENEFICIARY DESIGNATION a. Duke Human Resources 705 Broad St. The word beneficiary has its roots in the Latin benefactum, meaning good deed. Metropolitan Life Insurance Company BENEFICIARY DESIGNATION Please read Instructions on next page before completing this form. Unless the Insurance Company has been notified of a community or marital property interest in this contract, the Insurance Company will rely on its good faith belief that no such interest exists and will assume no responsibility for inquiry. The Prudential Insurance Company of America - California COA # 1179. contract owner. Footer Disclaimer. Call the GIC at 617.727.2310 for the form. Contract owners are urged to consult their own competent legal and/or tax advisors to verify impact of the laws in their own residence states when naming a beneficiary. Learn more about optional life insurance, beneficiary designation and the group life insurance provider. We will protect your rights to the life insurance proceeds to which you and your children may be entitled. A primary beneficiary will be the person/people/entity that you want to receive your life insurance benefits. Insurance products are issued by Minnesota Life Insurance Company or Securian Life Insurance Company, a New York authorized insurer. The information requested in the forms below is required for us to begin reviewing your claim. We are committed to providing the best service to our customers. Life insurance quote; Disability insurance quote; Dental insurance quote; Absence Management tool; Solutions for. NE, Cedar Rapids, IA 52499 3 BEN-CCC 02/14 Beneficiary Change Form **Please Note: All policy owners must sign this Beneficiary Designation Form. Be sure you sign and date the bottom of this form. 0%. Brighthouse Life Insurance Company • Brighthouse Life Insurance Company of NY • New England Life Insurance Company This form is to be used to assign or release an Irrevocable Beneficiary Designation. Beneficiary Change. R0782GHB (Rev. GROUP LIFE INSURANCE . Box 9389 . Assignee(s) – Required when the policy has an active assignment(s) and the assignee’s signature, or consent is required according to the assignment agreement. Life and disability insurance, annuities, and life insurance with long-term care benefits are issued by The Northwestern Mutual Life Insurance Company, Milwaukee, WI … That form will take precedence over any FEGLI designation form on file, as long as you sign it, have two witnesses sign, and complete the rest of the form properly. The Company waives any policy provision requiring the return of the Policy to the Company for endorsement. Download Documents. Transamerica Life Insurance Com Policy Number: Insured’s Name: Check if new address update is needed. Payment will be made in equal shares (unless otherwise specified). Beneficiary forms must be mailed to the appropriate address as noted on the form. See “SECTION IV – Signature” on page 3. Beneficiary Designation Form - Basic and Voluntary. Name(s) (please print) Group Term Life Insurance Beneficiary Designation • This form . Download a beneficiary form: For group life insurance through your employer/former employer (PDF) For individual life insurance purchased through a financial professional (including ported coverage) (PDF) For annuity contracts (PDF) Submit a disability insurance claim BENEFICIARY DESIGNATIONS DEFINITIONS: The purpose of designating beneficiaries for this policy is to instruct Anthem Life Insurance Company (Anthem Life) exactly how you wish the proceeds of your policy/certificate to be paid upon your death. Only the legal owner of the policy may change a beneficiary designation. Term Life Insurance is an affordable way to help protect your family's future. designation should be listed as “all children of the insured.” 6. Beneficiary designation, revocation or addition (PDF, 679 KB) Opens in a new window. If you find yourself in a situation where there might be a competing claim from an ex-spouse, call Kadetskaya Law Firm for a free consultation. 3. Please type or print your responses below. Things to know before you begin • This form . Metropolitan Life Insurance Company . NEA Insurance Operations. designation should be listed as “all children of the insured.” 6. Use this form to change Beneficiaries on your life insurance policies. If change of ownership and beneficiary is needed please use the Ownership and beneficiary designation request form applicable for your state (listed below). Metropolitan Life Insurance Company Page 1 of 3 GR-TR-BENE-MET2 (12/12) Fs . Independent licensees of the Blue Cross and Blue Shield Association. This beneficiary form applies to the HealthChoice Life Insurance Plan offered through the Office of Management and Enterprise Services Employees Group Insurance Division. Page 2 of 2. Life Owner Change Request ... Once you have completed a form, mail or fax it back to AAA Life Insurance Company using the contact information provided here. Metropolitan Life Insurance Company Page 3 of 3 GR-TR-BENE-EMP2 (10/12) Fs SECTION III - Signature Check if you are completing and signing this form as agent for the employee under a valid Power of Attorney. EMPLOYEE INFORMATION (Please write above line) _____ Box 105448 Atlanta, GA 30348-5448 Phone: 800-813-5682 Fax 877-305-3901 Email: lifeanddisabilityclaims@anthem.com . You can designate all or just a portion (for instance, a certain percentage) of your life insurance benefit to a charity, and your agent can help you with the beneficiary designation form to ensure your benefit gets in the right hands. • The beneficiaries you name on this form apply to your Group Term Life insurance coverage insured by MetLife. Change in Beneficiary Form . This form defines who are the children are (sometimes referred to as 'issue') of a predeceased beneficiary with the per stirpes designation, for distribution of proceeds of that predeceased beneficiary's portion. Step 1 - Guidance. Health Insurance Buy Out Election Form - Buy out GIC health insurance if you have proof of alternate coverage beginning in the new Fiscal Year. An irrevocable beneficiary is a designation that cannot be changed without the irrevocable beneficiaries’ written consent. You may name the same or different beneficiary for your UC Retirement Plan and/or Senior Management Life, if any. General Information about Beneficiary Designations Use this form: as a new hire If you want to change the beneficiary on a policy that has a separate rider covering an insured, including your spouse and/or children, In order to be valid, this form must be signed and dated prior to submitting it to OSU Benefits, 106J Whitehurst, Stillwater, OK 74078. ** Dependent Beneficiary – In the event a dependent dies, the employee is the beneficiary of their life insurance proceeds. Note: If you submitted a beneficiary designation form while previously employed by IBM, you must complete and submit a new form. Beneficiary Designation Form - GUL. each The Power of Attorney paperwork is subject to review by MetLife. Group Life. Learn More #7d63a5. BENEFICIARY DESIGNATION FORM Life Insurance Company of North America. If any of the primary beneficiaries you name qualify to receive money, … If no primary or contingent beneficiary is living upon the death of the contract owner, then the death benefit is payable to the contract owner’s estate. The Retired Member Designation of Beneficiary form allows a retired member to nominate a beneficiary, or beneficia- ries, for benefits payable upon the death of that retired member. All life coverage benefits may be found in the Life Certificate. When Life Insurance Is Part of an Estate A life insurance policy has one or more designated beneficiaries if the decedent completed a beneficiary designation form for the policy before their death. Life insurance benefits will be paid according to the standard order of beneficiary as follows: to the surviving spouse/domestic partner, if none, then Access a comprehensive list of Prudential forms for Annuities, Group Disability, Life Insurance, Mutual Funds, Investments & Retirement. SGL 180 See “SECTION III – Signature” on page 3. However, please note if your beneficiary is a minor at the time of claim, payments may be delayed due to special issues raised by these designations. n. Certain existing Ownership rights may require written consent of the Irrevocable beneficiary prior to processing. Des Moines, IA 50306-9389 . Life Insurance . Please refer to the Suggested Beneficiary Designations on the reverse side of this form. Group life insurance benefits (basic and optional life insurance). If you designate an irrevocable beneficiary, the Company will require the irrevocable beneficiary to consent in writing to 11/18 1 of 2 3325700 53967MUMENLBS 2019 Life Beneficiary Designation Prt FR 11 18 R2 Anthem Life The employer must eep this form on file. Return a copy of the Power of Attorney with this beneficiary form. When a significant event occurs in your life such as marriage, birth, death, divorce, or any change in family status, contact SURS to update your designation. Rev. See "SECTION 3 - Signature" on page 8. on this form for the above policy(ies) and relinquish your rights as a beneficiary. form: This form is used to request beneficiary changes on a life insurance policy. updated November 2012: Use this form to apply for VGLI insurance. Northwestern Mutual is the marketing name for The Northwestern Mutual Life Insurance Company and its subsidiaries. Next, complete the information regarding who will be your primary and contingent beneficiary(ies). The general distributor for variable products is Nationwide Investment Services Corporation (NISC), member FINRA, Columbus, Ohio. An irrevocable beneficiary is a designation that cannot be changed without the irrevocable beneficiaries’ written consent. * If more than one primary beneficiary is appointed, proceeds will be payable to them in equal shares unless stated otherwise. In states that have automatic revocation, an insured can comply with a court order to name a support obligee as beneficiary by completing a new beneficiary designation form following the divorce redesignating the former spouse as beneficiary. And that’s a good way to think of naming someone, or someones, or something, as a beneficiary on your term life insurance policy.Simply put, a life insurance beneficiary is the person who will receive a policy payout (called a death benefit) if you were to die with coverage in place. We offer all of our documents in one place for you to easily download. Close I have a Retirement Account, Annuity Account, Life Insurance Policy, Group Benefits Policy or Brokerage Account. Complete this step to assign a beneficiary to receive proceeds because of the death of the: If a class is not selected, it will be deemed that the named beneficiary is a primary beneficiary. children’s term rider, additional insured rider) Release of Interest in Claims Proceeds by Beneficiary Form Securities and Insurance Products: Group Term Life Insurance Beneficiary Designation . If the designation is in a form satisfactory to the Company, the change will be effective on the date signed by the Owner. Beneficiary Designation for Hong Kong Life Insurance One of the most important parts of setting up a life insurance plan in Hong Kong is choosing who will benefit from the policy. Return a copy of the Power of Attorney with this beneficiary form. Designation of Beneficiary Federal Employees' Group Life Insurance (FEGLI) Program Date (mm/dd/yyyy) Form Approved OMB No. Download and print the Group Term Life Insurance Designation of Beneficiary form for Government Employees's Benefit Association - GEBA. Please note: If your policy paperwork includes the Assurant Employee Benefits name or logo, or is underwritten by Union Security Insurance Company or Union Security Life Insurance Company of NY; please click here to access your forms.If you are unsure about which form to use, please contact your HR department or benefits administrator. SAMBA TERM LIFE INSURANCE Beneficiary Designation Form Mail or fax completed form to: SAMBA, 11301 Old Georgetown Road, Rockville, MD 20852-2800 1-800-638-6589 Fax (301) 816-0191 AUTHORIZATION AND ACKNOWLEDGEMENT Name of Insured _____ Date % (total must Employee’s Primary Beneficiary(ies): Relationship to Employee Social Security Number of Birth equal 100%) Date % (total must PROVISIONS 1. Group Life Insurance and IBM Travel Accident Insurance Policies, or you may complete a separate form for each policy if you wish to designate different beneficiaries. These are individuals (or an individual) who will receive the death benefit of the plan; these recipients of the policy benefits are known as Beneficiaries . The plan administrator for life insurance benefits is Securian Financial.Members should maintain an up-to-date Beneficiary Designation form especially when life-changing events, such as marriage or divorce, occur. Time for a little word play. If you’re considering making changes to your Variable Universal Life policy, we strongly urge you to contact your State Farm agent first. Assets such as life insurance, annuities and retirement accounts (401(k)s, IRAs, 403bs and similar accounts) all pass by beneficiary designation. I hereby certify that the information provided on this form is true and correct to the best of my knowledge. Use this form to name primary and secondary beneficiaries for your WRS Retirement Benefit and your Wisconsin Public Employers Life Insurance. You MUST return all pages of this form. Anthem Life Insurance Company Life Claims Service Center P.O. This form applies to both the group life insurance and pension benefits. Beneficiary Designation/Change Guidelines Please note: This document is for general information only. We would like to show you a description here but the site won’t allow us. To add or change the designated beneficiary for a tax-deferred or income annuity, use the form below in the Annuities section or request online: Beneficiary Form for Annuities (PDF) . Designation of Beneficiary: Use this form to designate or change the beneficiary for your government life insurance policy. A life insurance company will not release a policy payout to a child who has not reached the “age of majority” (typically 18 or 21 depending upon the state). Minors as Beneficiary Designation can be done by using this document. This form applies to the group life insurance for active and retired members of the ABP or DCRP. While the decision is ultimately yours, most people designate a spouse, child, charity, or multiple beneficiaries as their primary beneficiary. Click on a section to navigate to or scroll down to each section. To qualify to receive money from the IRA, a human beneficiary must be alive on the day after your death, and a trust, charity, or estate must be in existence within nine months after your death. Insurance 101; Investments 101; Find options. PART B. VRS BASIC GROUP LIFE INSURANCE – CONTINUATION List additional beneficiaries for basic group life insurance in the area below that were not included on the VRS-2 being submitted with this form. Insured s Socia l Security No. It's important that you provide us with complete and accurate information to avoid a delay in the processing of your claim. Date (mm/dd/yyyy) BENECHANGE (04/18) Life insurance change of Beneficiary . If the annuitant dies before the change is recorded, the change will not affect payments already paid. Index Universal Life withdrawal, loan or surrender request Please provide details for . If you are retired, it does not affect the beneficiaries for any death benefit you may have through your retirement system. Anthem Life Insurance Company Life Claims Service Center P.O. This form is used to change the beneficiary on 1) life insurance policies that cover a single insured or jointly cover two insureds and 2) annuity policies. THE EMPLOYER MUST KEEP THIS FORM ON FILE. Beneficiary Designation Form . 2. Designation of Beneficiary Form Group Insurance Contract: NP01002 Nationwide Life Insurance Company Home Office: Columbus, Ohio Send PERSONNEL CABINET COPY TO: Department of Employee Insurance Optional Insurance Branch 501 High St, 2nd Floor Frankfort, KY 40601 E. Beneficiary Designation/Change This Designation of Beneficiary is subject to all “Conditions” shown on the reverse side of this form. For more information on who will receive life insurance proceeds when an insured person dies, please check out our FAQ pages. Employers; Brokers; Medicaid & Medicare; Advice & Guidance. The Insurance Information Institute (III) recommends you also select a contingent beneficiary as next in line for the benefits in case your primary beneficiary cannot be found or dies. 21131 11/2020 3 My beneficiary changes Continued from previous page STEP 5A Only complete this step if your policy is a “Family” life insurance plan. Group Life is life insurance provided by your organization for which they pay the premiums. For help with beneficiary changes to Annuity products, contact the Annuities Operation Center at 877-543-3619.. The UTMA is a type of trust that you can arrange without an attorney. Be sure to name names. An alternate beneficiary designated to receive insurance proceeds if there is no eligible primary beneficiary. • If you need more space, attach an additional sheet of paper with all of the information required. ... Other products and services referenced in this website, such as life insurance, annuities, health insurance, credit insurance, and pension products, are written through multiple companies. Claim Forms . This Beneficiary Designation cancels all prior Beneficiary Designations and settlement agreements for the Policy identified by the number above. You may name more than one beneficiary and specify the percentage that each beneficiary is to receive on UC Retirement At Your Service (UCRAYS) or by submitting form UBEN 116 . Office of Personnel Management (OPM) Forms › The Office of Personnel Management provides online access to Office of Personnel Management Forms (OPM), Standard Forms (SF), Optional Forms (OF), and Federal Employees Group Life Insurance Forms (FEGLI). Find peace of mind with whole life insurance from Gerber Life. Metropolitan Life Insurance Company Page 1 of 3 GR-TR-BENE-MET2 (12/12) Fs . Metropolitan Life Insurance Company BENEFICIARY DESIGNATION Please read Instructions on next page before c omp leting this for m. D o not erase or attempt to make corrections; use a new form . reliance thereon. CalPERS and departmental beneficiary designations do not apply to life insurance benefits payable under the Metropolitan Life Insurance (MetLife) program. Use a new form.) The ETF beneficiary designation is the only legal way to distribute your death benefits. BENEFICIARY DESIGNATION FORM Policy Number Name of Policy Owner GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY THE GREAT-WEST LIFE ASSURANCE COMPANY PO Box 85056 Lincoln, NE 68501-5056. Proceeds will be paid as designated below. Beneficiary Designation. Yes, this is one of the most common reasons for life insurance disputes. Miami-Dade County pays the premium to cover employees for Basic Life Insurance at an amount equal to the employee's annual adjusted base salary. Complete the beneficiary designation (FIRST, SECOND), using the sample wordings on Page 2 as a guide for completing your designation. This form applies to both the group life insurance and ... Livonia, Michigan. Form Approved Designation of Beneficiary OMB No. Download this Beneficiary designation form to make a beneficiary designation as described in your contract and permitted by law (Note the document may download to the left lower corner of your screen, depending on your browser settings). 3/2020) Page 2 Instructions. In most cases, it makes better sense to name your beneficiaries individually on life insurance policies versus naming a trust as beneficiary. Veterans' Group Life Insurance (VGLI) Forms Form Description; SGLV 8714 Application for Veterans' Group Life Insurance. The Prudential Life Insurance Company of America Newark, NJ. FLX-965530 Child(ren)'s Beneficiary(ies): Relationship Social Security Number Date of Birth % (total must equal 100%) Use this form to: • Designate a different beneficiary from any DECEASED BENEFICIARIES - Unless otherwise provided in this form, the interest of any deceased benefi ciary shall be shared by the surviving If you designate an irrevocable beneficiary, the Company will require the irrevocable beneficiary to consent in writing to

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