Change Of Beneficiary Request Form – Fill Out and Use This PDF

The Change Of Beneficiary Request Form is a document that you submit to the Social Security Administration. This gives permission for your beneficiary to receive payments in case of death or disability. The form indicates who will be your legal representative when this takes place.

By clicking the button below, you will open our PDF editor that allows you to edit this form quickly. The application is meant to let you get access to any PDF you want with the aid of our multifunctional toolbar. It can be done on pretty much any platform, at any time!

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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.

Question	Answer
Form Name	Change Of Beneficiary Request Form
Form Length	1 pages
Fillable?	Yes
Fillable fields	71
Avg. time to fill out	14 min 27 sec
Other names	hartford beneficiary form, change beneficiary form, beneficiary request form, 101954hl

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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

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How to Edit Change Of Beneficiary Request Form Online for Free

It is possible to create the change beneficiary form online document with this PDF editor. These actions will allow you to easily create your document.

Step 1: Search for the button "Get Form Here" on the following site and press it.

Step 2: At this point, it is possible to edit the change beneficiary form online. This multifunctional toolbar makes it possible to include, erase, adapt, highlight, and also undertake other commands to the words and phrases and fields inside the form.

The PDF template you wish to prepare will consist of the next sections:

completing 101954hl part 1

Make sure you fill out the Name, Address, Name, Address, Name, Address, Social Security Number, Date of Birth, Relationship to Insured, Percentage, City, State, Zip Code, Phone Number, Social Security Number, Date of Birth, Relationship to Insured, Percentage, City, State, Zip Code, Phone Number, Social Security Number, Date of Birth, Relationship to Insured, Percentage, City, State, Zip Code, Phone Number, Section D - Signatures (you must, Policy, owner's Telephone Number, Signature of Co, owner (with title, Date mm, dd, yyyy and Date mm, dd, yyyy space with the expected information.

101954hl Name, Address, Name, Address, Name, Address, Social Security Number, Date of Birth, Relationship to Insured, Percentage, City, State, Zip Code, Phone Number, Social Security Number, Date of Birth, Relationship to Insured, Percentage, City, State, Zip Code, Phone Number, Social Security Number, Date of Birth, Relationship to Insured, Percentage, City, State, Zip Code, Phone Number, Section D - Signatures (you must, Policyowner

You may be expected to type in the data to help the application complete the field Signature of Witness (person, Have you, • completed Section A and provided, 101954, HL Date mm, dd, yyyy For standard mail delivery: The, and Page 1 of 1 (Rev.

stage 3 to entering details in 101954hl

Step 3: Once you click the Done button, your prepared form may be exported to any of your devices or to email given by you.

Step 4: Be sure to stay clear of potential problems by producing a minimum of a couple of duplicates of the file.

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