Change Of Beneficiary Request Form PDF Details

The Change of Beneficiary Request Form is an important form that can be used to change the beneficiary for your retirement plan. If you are married, you may want to use this form in order to designate a new beneficiary if something happens to your spouse. You should also keep in mind that when you change beneficiaries on any type of account (retirement, life insurance, etc.), the name will automatically be changed on all other accounts with the same name - so make sure it's worth it! This blog post provides information about what this form does and how to fill out its fields. It also includes tips for ensuring everything goes smoothly when changing beneficiaries, such as which documents need signatures and who needs copies after filling out the request.

You can definitely find it helpful to know how much time you'll need to fill out this change of beneficiary request form and how long the form is.

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.

Watch Change Of Beneficiary Request Form Video Instruction

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