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Beneficiary Change Form – Fill Out and Use

The Beneficiary Change Form is a document that allows you to change who will receive the proceeds of your insurance policy if you pass away.

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Beneficiary Change Details

If you have a change in your beneficiary designations after you have already completed your retirement plan paperwork, it is important to file a Beneficiary Change Form (often called a " beneficiaries designation form ") with the appropriate retirement plan administrator. This will ensure that your money goes to the right people when the time comes. The process for doing this may vary depending on the type of retirement plan you have, so be sure to check with your administrator for specific instructions. In most cases, however, you will need to provide the following information: name of beneficiary, relationship to account holder, and mailing address or other contact information for beneficiary.

You may find information regarding the type of form you need to complete in the table. It will show you how much time you will require to fill out beneficiary change form, exactly what fields you need to fill in and a few further specific facts.

Question	Answer
Form Name	Beneficiary Change Form
Form Length	3 pages
Fillable?	Yes
Fillable fields	94
Avg. time to fill out	19 min 37 sec
Other names	banner life beneficiary designation form, banner life change of beneficiary form, beneficiary change form, beneficiary change

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Banner Life Insurance Company 3275 Bennett Creek Avenue Frederick, Maryland 21704 (800) 638-8428

BENEFICIARY CHANGE FORM

(Please Print Clearly)

Insured: _______________________________________________

Policy Number: ______________________________

1.The policy proceeds payable upon the death of the insured will be paid to the beneﬁciaries named herein. The rights of the beneﬁciary will be subject to the rights of any assignee on record. If no percentage is provided, proceeds will be divided equally among all surviving beneﬁciaries. All prior revocable designations of Primary and Contingent beneﬁciaries are hereby revoked.

Primary Beneﬁciary (If additional space is needed, please attach a separate page, signed and dated. SSN or Tax ID

# and Date of Birth are REQUIRED.)

Name ____________________________________________________	SSN or Tax ID # ___________________
Address___________________________________________________	Date of Birth ______________________
City, State __________________________________Zip ____________	Telephone # ______________________
Relationship to Proposed Insured_______________________________	% Share _________________________
Name ____________________________________________________	SSN or Tax ID # ___________________
Address___________________________________________________	Date of Birth ______________________
City, State _________________________________Zip _____________	Telephone # ______________________
Relationship to Proposed Insured_______________________________	% Share _________________________
Name ____________________________________________________	SSN or Tax ID # ___________________
Address___________________________________________________	Date of Birth ______________________
City, State __________________________________Zip ____________	Telephone # ______________________
Relationship to Proposed Insured_______________________________	% Share _________________________
Name ____________________________________________________	SSN or Tax ID # ___________________
Address___________________________________________________	Date of Birth ______________________
City, State _________________________________Zip _____________	Telephone # ______________________
Relationship to Proposed Insured_______________________________	% Share _________________________
Name ____________________________________________________	SSN or Tax ID # ___________________
Address___________________________________________________	Date of Birth ______________________
City, State __________________________________Zip ____________	Telephone # ______________________
Relationship to Proposed Insured_______________________________	% Share _________________________

LP-159 (7-12)

Contingent Beneﬁciary (If additional space is needed, please attach a separate page, signed and dated. SSN or Tax ID # and Date of Birth are REQUIRED.) A Contingent Beneﬁciary will receive the beneﬁts in the event no Primary Beneﬁciary is living or exists at the time of the insured’s death.

Name ____________________________________________________	SSN or Tax ID # ___________________
Address___________________________________________________	Date of Birth ______________________
City, State _________________________________ Zip _____________	Telephone # ______________________
Relationship to Proposed Insured_______________________________	% Share _________________________
Name ____________________________________________________	SSN or Tax ID # ___________________
Address___________________________________________________	Date of Birth ______________________
City, State __________________________________ Zip ____________	Telephone # ______________________
Relationship to Proposed Insured_______________________________	% Share _________________________
Name ____________________________________________________	SSN or Tax ID # ___________________
Address___________________________________________________	Date of Birth ______________________
City, State _________________________________ Zip _____________	Telephone # ______________________
Relationship to Proposed Insured_______________________________	% Share _________________________
Name ____________________________________________________	SSN or Tax ID # ___________________
Address___________________________________________________	Date of Birth ______________________
City, State _________________________________ Zip _____________	Telephone # ______________________
Relationship to Proposed Insured_______________________________	% Share _________________________

2.No proceedings in bankruptcy or insolvency, voluntary or involuntary, are pending against the undersigned, nor is the under- signed under guardianship or any other legal disability. This designation shall be invalid if the person making it does not have the right to change the beneﬁciary under the policy speciﬁed. Any payment made by Banner Life Insurance Company in good faith pursuant to the foregoing designation shall fully discharge Banner Life Insurance Company of its liability under the policy.

Required Signatures:

____________________________________________		_______________________________________________
Print Policy Owner Name		Telephone Number
____________________________________________		_______________________________________________
Street Address		Email Address
____________________________________________
City, State, Zip
____________________________________________		_______________________________________________
Signature of Policy Owner / Title	Date	Additional Signature** (if necessary)	Date

For Massachusetts residents, state law requires that a disinterested adult who is not a party to the policy witness this request.

__________________________________________________

Signature of Witness (Massachusetts Only) Date

**AZ, CA, ID, LA, NV, NM, TX, WA, WI, and Puerto Rico are community property law states. These laws may apply depending on your current marital status, marital status at the time of policy issuance, state where your policy was issued, residence state at time of issuance, and residence state(s) since issuance. Consult with your legal or tax advisor to determine whether these laws apply to you and whether a spousal signature is required on this form. Banner Life Insurance Company disclaims any responsibility for determining the applicability of community property laws or the validity of the requested change.

LP-159 (7-12)

3.To process your request without delay, please make sure the following have been completed:

Did the Policy Owner(s) sign and date the form?

Did you provide the SSN or Tax ID #, Telephone # and Date of Birth for all beneﬁciaries?

Do the percentage totals equal 100%?

Did you include the spousal signature if applicable?

Did you include an additional signature if applicable?

If you designated more than 5 Primary or Contingent Beneﬁ ciaries, did you attach an additional page signed and dated?

Did you enclose the title and signature page of trust if listed as a beneﬁciary?

BENEFICIARY DESIGNATION INFORMATION

The beneﬁ ciary designation form is an IMPORTANT DOCUMENT concerning your life insurance coverage, please read the following carefully. If multiple Primary Beneﬁ ciaries or Contingent Beneﬁ ciaries are named and no percentage distribution is noted, then any proceeds payable to such beneﬁ ciaries will be split equally. Unless otherwise speciﬁ ed, if there is more than one Primary Beneﬁciary, and one predeceases the insured, beneﬁ ts will be paid to the surviving Primary Beneﬁ ciaries according to their respective interests. If no Primary Beneﬁ ciaries survive the insured, beneﬁ ts will be paid to the designated Contingent Beneﬁ ciaries. In the event that no Primary or Contingent Beneﬁ ciary survives the insured, beneﬁ ts will be paid to any designated Tertiary Beneﬁ ciary, or if none, as speciﬁed according to the terms of the policy. Beneﬁ ciary designation changes may have legal or tax consequences, please consult your legal or tax advisor to discuss your individual needs. Once received, the beneﬁ ciary designation will replace all prior designations for the indicated policy.

Examples of Frequently Used Beneﬁciary Designations

Proposed Beneﬁciary

One beneﬁ ciary

All children (unnamed)

Minor children

Suggested Wording

Jane Jones Doe, wife.

To all my lawful children, in equal shares with rights of survivorship. (unless speciﬁed proceeds will be paid to all surviving lawful children).

John Smith, custodian for Mary Doe, a minor, under the Uniform Transfers to Minors Act (UTMA). [Beneﬁ ts cannot be paid to minor children unless to a custodian under UTMA or a court appointed ﬁ nancial guardian or guardian of the minor’s estate].

An existing trust

A trust under a last will and testament

Estate

Non-proﬁ t organization

Children, per stirpes

Speciﬁ ed secondary beneﬁ ciary

The John Doe Irrevocable Trust, dated 1/1/2001, Eric Smith trustee.

Trustee under my last will and testament as shall be admitted to probate. [Should only be used if an appropriate trust has been set forth within the insured’s will].

To my Estate.

Name and address of the beneﬁciary organization.

To all my lawful children, per stirpes. (Surviving grandchildren of a pre-deceased child will equally share that child’s portion; this option could also be used for named children).

Jane Jones Doe, wife, if predeceased then Mary Ann Doe, sister. (Used to designate a Secondary Beneﬁciary rather than distribute a predeceasing Primary Beneﬁciary’s share to the remaining Primary Beneﬁ ciaries, please provide Date of Birth and SSN or Tax ID # for the Secondary Beneﬁ ciary in the Comments section).

Irrevocable beneﬁ ciary

Jane Jones Doe, wife, irrevocable beneﬁciary.

Contact Information
Legal & General America	1-800-638-8428	(telephone)
Banner Life Insurance Company	1-301-294-6960	(fax)
3275 Bennett Creek Avenue	customerservice@bannerlife.com
Frederick, Maryland 21704	Faxed, email or mailed copies will be accepted.

LP-159 (7-12)

How to Edit Beneficiary Change Form

It's super easy to prepare the banner life insurance change of beneficiary form. Our software was intended to be allow you to fill out any document quickly. These are the four actions to go through:

Step 1: Choose the orange "Get Form Now" button on the website page.

Step 2: Once you have entered the banner life insurance change of beneficiary form edit page, you'll see all actions it is possible to take regarding your file within the upper menu.

You'll have to enter the following information if you want to fill in the document:

banner life beneficiary change empty spaces to fill in

The system will require you to complete the Name, Address, City, Telephone # ______________________, Relationship to Proposed Insured, Name, Address, City, Telephone # ______________________, Relationship to Proposed Insured, and Name area.

Entering details in banner life beneficiary change part 2

Be sure to point out the important particulars from the Address, City, Telephone # ______________________, Relationship to Proposed Insured, Name, Address, City, Telephone # ______________________, Relationship to Proposed Insured, and LP-159 (7-12) segment.

banner life beneficiary change Address, City, Telephone # ______________________, Relationship to Proposed Insured, Name, Address, City, Telephone # ______________________, Relationship to Proposed Insured, and LP-159 (7-12) blanks to fill

The area Contingent Beneﬁ ciary (If, Name, Address, City, Telephone # ______________________, Relationship to Proposed Insured, Name, Address, City, Telephone # ______________________, and Relationship to Proposed Insured will be where to place all parties' rights and obligations.

banner life beneficiary change Contingent Beneﬁ ciary (If, Name, Address, City, Telephone # ______________________, Relationship to Proposed Insured, Name, Address, City, Telephone # ______________________, and Relationship to Proposed Insured fields to fill

Check the sections Name, Address, City, Telephone # ______________________, Relationship to Proposed Insured, Name, Address, City, Telephone # ______________________, and Relationship to Proposed Insured and then fill them out.

Completing banner life beneficiary change part 5

Step 3: If you are done, click the "Done" button to upload your PDF form.

Step 4: Produce a duplicate of every single document. It will certainly save you some time and enable you to keep clear of troubles later on. By the way, your details isn't shared or analyzed by us.

Beneficiary Change Form – Fill Out and Use

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