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Life insurance is a contract between a policyholder and an insurance provider. In essence, it says: "If you make all of your insurance payments as agreed upon in our contract, we, the insurance company, promise to pay out a benefit to your loved ones—the beneficiaries—when you die." Is this a Change of Beneficiary? Yes No Yes No. Primary Beneficiary Name: Relationship. Address *A contingent Beneficiary will only receive proceeds if all Primary Beneficiaries have predeceased the Insured. Subscriber Signature In order to change your beneficiaries, the following must be done Employees enrolled in the Group Life Insurance plan must complete a Beneficiary Change Form. Contact the HR Employee Resource Center, 860-679-2426 (HR-EmployeeResource@uchc.edu). Beneficiary Change Form. Employer Name. This beneficiary designation applies to all funding options (including life insurance) unless otherwise noted. For payout purposes, the Plan Administrator will establish sub-accounts and not separate accounts for beneficiaries, which in the case of multiple Details: Change of Beneficiary Form This is a letter template for an owner of an insurance policy to send to the insurance company to change the designation of Use this form to change Beneficiaries on your life insurance policies. The company indicated in this section is referred to as "the Company." • This form applies to all companies owned and administrated by Unified Life Insurance Company. • Only the owner of an insurance policy may name or change the beneficiary. If an irrevocable beneficiary has previously been named, we must have his or her signature on the change form also. USE THIS FORM TO: • Change a Beneficiary. • • Change the Account Holder of an existing Account. This paper clip indicates you may need to attach documentation. RETURN THIS FORM TO: T. Rowe Price P.O. Box 17302 Baltimore, MD 21297-1302. Beneficiary Change Request. In this form you and your refer to the policy owner, while we, us, our, and the Company refer to Sun Life of Canada (Philippines) Purpose of the form: This form is used to change the designated beneficiaries who will receive the benefits in the event of the insured's death. Beneficiary designation form instructions. You must select your beneficiary - the Initial Beneficiary Designation(s) OR Change of all prior beneficiary designation(s) (check NAMING YOUR GROUP LIFE BENEFICIARY It is important that your beneficiary designation be clear so To designate your beneficiary or change your designation, contact bp Retirement Services at Fidelity online or at 1-877-272-3334. Properly complete any required forms, such as a notarized consent, and return them to bp Retirement Services at Fidelity for your new or changed beneficiary Change forms. Download this form and print it, or fill it out in Adobe Reader XI or higher (not your browser) and save. Portable benefits beneficiary designation - M5981 (PB177914) | PDF 90 kb. Use this form to designate 1 or more beneficiaries to receive a payout from your portable benefits plan. Change of Beneficiary Form. Beneficiary's Name (First, Middle Initial, Last), Entity Name or Change of Beneficiary Form. Form must be signed by owner, dated, and witnessed Individual Owner. This space for Home Office use only TEXAS LIFE INSURANCE COMPANY. Date Recorded. Change of Beneficiary Form. Beneficiary's Name (First, Middle Initial, Last), Entity Name or Change of Beneficiary Form. Form must be signed by owner, dated, and witnessed Individual Owner. This space for Home Office use only TEXAS LIFE INSURANCE COMPANY. Date Recorded. This Beneficiary Change Form is provided for your convenience in handling changes or corrections to the beneficiary information for your contract. Metropolitan Life Insurance Company. Things to Know Before You Begin: • Please review Section 6: Good Order Guide and Definitions for. Beneficiary Change Request. Use for Life Post Issue only; not for use with Annu-ities, Qualified Plans or Disability Income. If both individual and entity beneficiaries are being named on this form, enter the entity information in section C - Entity Beneficiary Information on page four.

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