Change Of Beneficiary Request Form PDF Details

When the time comes to update who will receive the benefits from your insurance policy, making sure the process is handled correctly is paramount. For many, this involves filling out a Change of Beneficiary Request Form, a document designed to formally request the alteration of who is designated to receive benefits under an insurance policy. This process is one that can only occur during the lifetime of the insured, ensuring that the wishes of the policy owner are honored to the letter. Upon successful submission and the insurer's acceptance of this document, the changes take effect retroactively from the date the policy owner signed the form, regardless of the insured person's status at the time of processing. However, any payments or actions taken by the insurer prior to the form's completion will remain unaffected. The form guides the policy owner through providing essential details, whether the new beneficiary is an individual or a trust, and outlines the need for specific information like social security numbers, relationships to the insured, and desired percentage allocations for each beneficiary. It is designed to revoke any previous beneficiary designations, with options to update both primary and contingent beneficiaries, ensuring that the policy owner's current wishes are clearly documented and executed. Completing this form requires careful attention to detail and adherence to specific instructions, including the necessity of witness signatures to foster legitimacy and prevent potential disputes. This crucial document underscores the importance of keeping beneficiary information current and reflects the policy owner's evolving wishes, securing peace of mind for all involved.

QuestionAnswer
Form NameChange Of Beneficiary Request Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameshartford change beneficiary form, hartford beneficiary form, change beneficiary form printable, change beneficiary form online

Form Preview Example

Change of Beneficiary Request Form

Beneficiary change requests can only be made during the lifetime of the insured. Upon the Insurer’s receipt of this completed form, the Beneficiary change will be effective as of the date it was signed by the Policyowner and whether or not the Insured is living when we receive it. However, the change will be subject to any payment that the Insurer may have made or actions it may have taken prior to receipt of the completed form.

Important Instructions

1.If new beneficiary is a trust, a copy of the trust document must be submitted and the trust name and date must be included as the name in the information box below.

2.If additional space is needed, please attach a separate sheet which includes: 1) the policy number and name of insured; 2) the information requested in the box below; 3) signature of Owner(s) along with the date; and 4) the signature of a Witness.

3.For multiple beneficiaries, use percentages NOT dollar amounts. If no percentages are indicated, an equal division is assumed.

Contact Information:

Clients

Call 1-800-231-5453

Fax

Call 1-888-568-9705

Section A - Policy information (you must complete this section)

Policy Number

Insured's Name

Policyowner's Name

Section B - Primary beneficiary information

Primary – The undersigned hereby requests that all previous primary beneficiary designations and settlement options elected be revoked and makes the following designations (if no entry is made, previous designations and/or elections will remain unchanged):

Name

Social Security Number

Date of Birth

 

Relationship to Insured

Percentage

 

 

 

 

 

 

 

Address

City

State

Zip Code

 

Phone Number

 

 

 

 

 

 

 

 

Name

Social Security Number

Date of Birth

 

Relationship to Insured

Percentage

 

 

 

 

 

 

 

Address

City

State

Zip Code

 

Phone Number

 

 

 

 

 

 

 

 

Name

Social Security Number

Date of Birth

 

Relationship to Insured

Percentage

 

 

 

 

 

 

 

Address

City

State

Zip Code

 

Phone Number

 

 

 

 

 

 

 

 

Section C - Contingent beneficiary information

Contingent (secondary) – Receives benefits ONLY if no Primary Beneficiary survives the insured. The undersigned hereby requests that all previous contingent beneficiary designations and settlement options elected be revoked and makes the following designations (if no entry is made, previous designations and/or elections will remain unchanged):

Name

Social Security Number

Date of Birth

 

Relationship to Insured

Percentage

 

 

 

 

 

 

 

Address

City

State

Zip Code

 

Phone Number

 

 

 

 

 

 

 

 

Name

Social Security Number

Date of Birth

 

Relationship to Insured

Percentage

 

 

 

 

 

 

 

Address

City

State

Zip Code

 

Phone Number

 

 

 

 

 

 

 

 

Name

Social Security Number

Date of Birth

 

Relationship to Insured

Percentage

 

 

 

 

 

 

 

Address

City

State

Zip Code

 

Phone Number

 

 

 

 

 

 

 

 

Section D - Signatures (you must complete this section)

Signature of Policyowner (with title if applicable)

 

Policyowner's Telephone Number

Date (mm/dd/yyyy)

 

 

 

 

Signature of Co-owner (with title if applicable) or Second Officer with title (if corporate-owned)

Date (mm/dd/yyyy)

 

 

 

 

Signature of Witness (person cannot be a designated Beneficiary)

Name of Witness (Please Print)

Date (mm/dd/yyyy)

 

 

 

 

 

 

 

 

Have you...

•completed Section A and provided us with complete Policyowner information?

•provided us with complete Primary beneficiary information in Section B?

•provided us with complete Contingent beneficiary information in Section C, if applicable?

•completed Section D by providing us with all appropriate signatures and dates?

101954HL

For standard mail delivery:

The Hartford

Individual Life Division

PO Box 64582

St. Paul, MN 55164-0582

Page 1 of 1

(REV. 12/12)

How to Edit Change Of Beneficiary Request Form Online for Free

It's easy to complete the change beneficiary form online gaps. Our software will make it virtually effortless to complete any sort of PDF. Down the page are the primary four steps you'll want to consider:

Step 1: Click the button "Get form here" to open it.

Step 2: You can now manage the change beneficiary form online. The multifunctional toolbar permits you to include, delete, transform, and highlight content material or perform many other commands.

It is important to provide the next details in order to prepare the file:

completing 101954hl step 1

Enter the necessary data in the field Name, Address, Social Security Number, Date of Birth, Relationship to Insured, Percentage, City, State, Zip Code, Phone Number, Section D Signatures you must, Policyowners Telephone Number, Signature of Coowner with title if, Signature of Witness person cannot, and Have you.

Filling in 101954hl part 2

Step 3: Choose the Done button to ensure that your completed document could be transferred to every electronic device you prefer or sent to an email you specify.

Step 4: Make sure you stay clear of possible worries by getting as much as a couple of duplicates of your document.

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