In the realm of insurance and financial planning, the intricacies of policy management are both crucial and complex. The FGLI 0177 form serves as a quintessential example of such complexities, facilitating vital changes that can have longstanding implications for policyholders and beneficiaries alike. Drafted by OM Financial Life Insurance Company, this document encompasses provisions for the transfer of ownership, alteration of beneficiaries, and modification of annuitants under specific insurance contracts. The form delineates a structured process allowing current owners to unequivocally transfer their ownership rights along with associated benefits and privileges to a new owner, which might include or exclude the right of survivorship depending on the express designations. Additionally, it outlines the necessary alterations to beneficiary designations, ensuring that such changes precede the ownership transfer to maintain continuity and clarity. For annuity contracts, it details the criteria and procedural requirements for designating a new annuitant, underscoring the contractual limitations and the need for precise compliance. The document further emphasizes the importance of obtaining professional financial or tax advice, reflecting a keen awareness of the potential fiscal ramifications inherent in these transactions. With stipulations for individual, corporate, and partnership ownerships, along with detailed beneficiary designation specimens, the FGLI 0177 form embodies a comprehensive tool for policy management, designed to safeguard the interests of all parties involved and ensure the seamless execution of ownership and beneficiary transitions.
| Question | Answer |
|---|---|
| Form Name | Form Fgli 0177 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | OM Ownership.Benef iciary.Annuitan t Change Request fidelity and guaranty beneficiary change form |
Transfer of Ownership/Change of Beneficiary/Change of Annuitant
I N S U R E R
OM Financial Life Insurance Company
I N S U R E D
Contract No.
Insured / Annuitant
P A R T A : T R A N S F E R O F O W N E R S H I P
The undersigned hereby transfers ownership of said, together with all rights and privileges incident thereto, including the right to receive all amounts payable during the insured’s lifetime to:
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New owner’s Social Security Number
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Relationship of joint owner to insured
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and to the executors, administrators, successors or assigns of the transferee, except that the naming of joint owners herein will create right of survivorship unless otherwise designated. If the subject contract is a juvenile contract (Issue age
P A R T B : C H A N G E O F B E N E F I C I A R Y
Effective immediately prior to the transfer of ownership provided in Part A above, the beneficiary designation under said policy is hereby changed as follows: (Please print name in full giving relationship to insured.)
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OM Financial Life Insurance Company Baltimore, MD
FGLI 0177 |
Rev. |
Transfer of Ownership/Change Beneficiary/Change of Annuitant - Page 2
P A R T C : C H A N G E O F A N N U I T A N T
Note: This change is subject to the annuity contract provisions and is not available on all annuity contracts. Please refer to your annuity contract or contact your insurance representative.
The Annuitant cannot be a
I hereby designate the Annuitant of the contract designated herein to:
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Reason for change:
*Proof of age is required for annuity types 2 through 7.
I M P O R T A N T N O T I C E
A separate form should be completed for each contract and forwarded to the Home Office. For transfer of ownership without change of beneficiary or change of annuitant, complete Part A only. Otherwise, complete applicable areas to be changed. See rules below regarding signature and other requirements if policy is owned by other than an individual, and for specimen beneficiary designations.
This transaction may be a taxable and reportable event. The Owner(s) is requesting this change pursuant to his/her own specific situation. To this end, the Owner(s) consulted with a financial or tax advisor and acknowledges that he/she is directing the applicable insurance company to effect the change. In addition, the Current and New contract owner(s), participant(s) plan administrator, if applicable, each agree to hold harmless and indemnify OMFN to any and all claims or demands which may be made by reason of the changes so made.
Dated at ____________________________________ this ____________ day of |
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Signature of Current Owner/Participant |
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Signature of Current Joint Owner/Participant |
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(If Corporation, signature and title of authorized officer.) |
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Signature of New Owner/Participant |
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Signature of New Joint Owner/Participant |
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(If corporation, signature and title of authorized officer.) |
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Witness to all signatures |
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Assignee or Irrevocable Beneficiary |
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Acknowledged and accepted by OM Financial Life Insurance Company:
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S I G N A T U R E R E Q U I R E M E N T S
If the transfer or exchange is executed by a corporation, a signature from each of two individual officers, authorized by the corporation to effect the assignment on behalf of the corporation, is required. If the above is executed by a partnership, all partners must sign and be designated as a partner. If the policy is owned by a pension or
S P E C I M E N B E N E F I C I A R Y D E S I G N A T I O N S
Insured’s Estate
One Primary and One Contingent – “Mary J. Doe, Insured’s Wife, if living at Insured’s death, otherwise equally to such lawful children of Insured (or substitute – ‘to such children of Insured by said wife’), as may then be living.”
Delayed Payment (Common Disaster) Clause – “Mary J. Doe, Insured’s wife, if living on the 30th day after the death of the Insured; otherwise . . . “
Corporation – “The Brown Paper Company, Inc., a Maryland Corporation, its successors or assigns.”
Partnership – “John Doe and Sons, a partnership consisting of John Doe, James Doe, and Robert Doe, its successors or assigns.”
Corporate Trustee – “First National Bank, Baltimore, Maryland, trustee, or its successors in trust, under trust agreement dated February 15, 1989.”
Individual Trustee – “John J. Jones Insurance Trust naming Mary Smith as trustee under trust agreement dated February 15, 1989.”
OM Financial Life Insurance Company Baltimore, MD
FGLI 0177 |
Rev. |