Beneficiary Change Form PDF 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.

QuestionAnswer
Form NameBeneficiary Change Form
Form Length2 pages
Fillable?Yes
Fillable fields42
Avg. time to fill out8 min 58 sec
Other namesbanner life insurance change of beneficiary form, beneficiary change form, teacher retirement system of texas change of beneficiary form, banner life insurance beneficiary change form

Form Preview Example

Name • Address • Beneficiary Change Form

Personal Information

Name:

Date of Birth:

 

 

SSN or Account Number:

 

 

 

 

Street Address:

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

State:

 

ZIP:

 

Home Phone:

 

 

 

Work Phone:

 

 

 

 

Email:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Request & Paperless Delivery Option

 

 

 

c Beneficiary Change

c Address Change

c Name Change*

 

 

 

*Proof of name change must be attached; i.e. copy of your driver’s license, Social Security card, or marriage certificate.

Paperless Delivery: By providing your email address you are consenting to receive statements, confirmations, terms, agreements and other information provided in connection with your retirement plan electronically. Unless you choose to have statements, account documents and other documents sent in connection with your retirement plan delivered via US Mail to the mailing address of record by checking the box below, these documents will be made available to you electronically

cI wish to receive my statements and account documents via US Mail.

Beneficiary Designation

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 beneficiaries may require that required minimum distributions be based on the life expectancy of the oldest beneficiary.

PLEASE NOTE: Percentage split must total 100% for each category of beneficiary.

If you select “Equal Percentage” for your beneficiaries, there may be some minor variance based upon the number of beneficiaries you have listed. For example: if you list three beneficiaries, the oldest beneficiary will be designated 33.34% and the other two will be 33.33%.

If additional space for beneficiaries is required, attach additional sheets and mark this box: c

Primary Beneficiary(ies) (must total 100%): c Equal Percentage

1. Full Name:

 

 

 

 

 

 

Date of Birth:

 

 

 

Relationship:

 

SSN:

 

Phone:

 

 

Split:

%

2. Full Name:

 

 

 

 

 

 

Date of Birth:

 

 

 

 

Relationship:

 

SSN:

 

Phone:

 

 

Split:

%

 

 

 

 

 

 

 

 

 

 

 

 

 

Contingent Beneficiary(ies) (must total 100%): c Equal Percentage

1. Full Name:

 

 

 

 

 

 

Date of Birth:

 

 

 

Relationship:

 

SSN:

 

Phone:

 

 

Split:

%

2. Full Name:

 

 

 

 

 

 

Date of Birth:

 

 

 

 

Relationship:

 

SSN:

 

Phone:

 

 

Split:

%

 

 

 

 

 

 

 

 

 

 

 

 

 

Authorization

This designation supersedes any prior beneficiary designation and shall become effective on the date accepted by the Plan as listed below prior to my death. My death benefits will be paid first to my Primary Beneficiaries. If some of my Primary Beneficiaries predecease me, then my death benefit will be paid to the remaining Primary Beneficiaries.

Contingent Beneficiaries will only receive benefits if no Primary Beneficiary survives me. If no beneficiary designation is on file, benefits will be paid pursuant to the sequence set forth in the Plan Document.

Signature:

 

Date:

 

 

DC-770 (07/2019)

For help, please call 877-NRS-FORU

 

nrsforu.com

1

Model Beneficiary Designations

Indicate the full names of the beneficiaries, their Social Security numbers, date of birth, relationship to you, address, phone number, and split you’d like each one of them to receive. Please use the following designations as a guide when completing this form.

 

Name

Split%

Relationship

SSN

Date Of Birth

1.

Primary: Joan Nation

100%

spouse

123-45-6789

01/02/1962

2.

Primary: Joan Nation

100%

spouse

123-45-6789

01/02/1962

 

Contingent: Henry Nation

100%

son

987-65-4321

06/26/1984

3.

Primary: Joan Nation

100%

spouse

123-45-6789

01/02/1962

 

Contingent: Henry Nation

50%

son

987-65-4321

06/26/1984

 

Contingent: Betty Nation

50%

daughter

305-24-9731

02/12/1980

4.

Primary: Henry Nation

50%

son

987-65-4321

06/26/1984

 

Primary: Betty Nation

50%

daughter

305-24-9731

02/12/1980

5.

Primary: Henry Nation

34%

son

987-65-4321

06/26/1984

 

Primary: Betty Nation

33%

daughter

305-24-9731

02/12/1980

 

Primary: John Nation

33%

son

876-91-3416

09/31/1986

6.

Primary: Sara Nation

60%

mother

811-61-1781

10/14/1950

 

Primary: George Nation

40%

father

916-18-1781

12/30/1945

 

Contingent: Jean Nation

100%

sister

913-19-3319

03/29/1971

7.Primary: My Estate

8.First National Bank of Canton, Ohio, as Trustee under Trust Agreement with Robert E. Nation dated January 1, 2002. (Attach a copy of the title and signature page of the Trust).

Generic beneficiary designations will not be accepted. Examples of generic designations include:

1.My spouse, parent(s), sister(s), brother(s), son(s), daughter(s).

2.My children.

3.Children of this marriage or any past marriage.

4.As designated in my will.

Form Return

By mail:

Nationwide Retirement Solutions

Email:

rpublic@nationwide.com

 

PO Box 182797

By fax:

877-677-4329

 

Columbus, OH 43218-2797

 

 

2

DC-770 (07/2019)

For help, please call 877-NRS-FORU

nrsforu.com

How to Edit Beneficiary Change Form Online for Free

Filling out files with this PDF editor is simpler compared to anything else. To edit banner life insurance beneficiary change form the document, you'll find nothing you need to do - only proceed with the actions listed below:

Step 1: Click the "Get Form Here" button.

Step 2: So, you can start modifying the banner life insurance beneficiary change form. Our multifunctional toolbar is at your disposal - add, erase, adjust, highlight, and do other commands with the text in the document.

Create the following segments to complete the file:

form beneficiary change form gaps to complete

Fill out the DateofBirth, Relationship, FullName, Relationship, SSN, SSN, Phone, Split, DateofBirth, Phone, Split, DateofBirth, Relationship, FullName, and SSN areas with any data that will be demanded by the program.

stage 2 to completing form beneficiary change form

Step 3: As soon as you are done, select the "Done" button to upload your PDF document.

Step 4: Ensure that you prevent future worries by creating around two duplicates of your form.

Watch Beneficiary Change Form Video Instruction

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .