Mony Group Change Of Benificiary Form PDF Details

Within the dynamic landscape of life insurance and policy management, the Mony Group Change of Beneficiary Form emerges as a critical document for policyholders aiming to amend their beneficiary designations or rights holders within their policy agreements. Encompassing both MONY Life Insurance and MONY Life Insurance Company of America, this form serves as a conduit for policyholders to precisely articulate their wishes regarding who should benefit from their policy upon their passing. Detailed instructions guide the policyholder through the process of nominating first and second beneficiaries, with the option to designate the insured’s estate or a specific entity in the absence of living beneficiaries. Additionally, the form allows for the transfer of rights to another individual or entity, thus accommodating various scenarios that might necessitate a change in policy ownership. Signatories must adhere to specified requirements, especially when representing corporations or partnerships, to ensure their authority is correctly recorded. The inclusion of sample wordings aids in the accurate expression of the policyholder's intentions, thereby minimizing ambiguities within beneficiary and rightsholder designations. Importantly, the form clarifies its applicability, including its non-usage for certain policy types and settlement options, while highlighting potential tax consequences and considerations for policyholders navigating post-divorce scenarios. Thus, this form not only simplifies the process of updating beneficiary information but also underscores the importance of clear communication between the policyholder and insurer to reflect current wishes and legal obligations.

QuestionAnswer
Form NameMony Group Change Of Benificiary Form
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesmony life insurance beneficiary forms, mony life insurance claim form, mony change form number 10481, mony form 10481

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❏ MONY Life Insurance

❏ MONY Life Insurance

Change of Beneficiary and/or

Company

Company of America

Rightsholder (Owner)

P.O. Box 4830

P.O. Box 4720

(Page 1 of 5)

Syracuse, New York 13221

Syracuse, New York 13221

 

 

 

FORM NO. 10481 (11/2006)

INSTRUCTIONS FOR COMPLETING THIS FORM

Section 1. Designation of Beneficiary and Method of Payment

Payment will be made in one sum. Settlement Option is not available unless elected on Beneficiary, Rights and Settlement Option Request (Form 4113).

Complete the beneficiary designation (FIRST, SECOND), using the sample wordings on Page 2 as a guide for completing your designation. It is not necessary to designate a SECOND beneficiary, but the space is provided if you choose to do so. The relationship of the proposed beneficiary(ies), to the Insured person must be stated in Section 1.

Use the full legal name — Linda Smith, not Mrs. John Smith.

Current law requires us to request the name and address of each beneficiary (including the current list of living members in a group designation like "my children") as well as the Relationship of each beneficiary named to the Insured. After completing the beneficiary designation in Section 1, you should provide this supplemental information below the name of each beneficiary noted on Page 4 in the space provided.

If you have named a person as beneficiary, the FINAL beneficiary will be the insured’s executors or administrators unless otherwise indicated. Is this your intent? Keep the rightsholder (owner) in mind. For example, if rights are vested in the Insured or the final rights revert to the Insured, the FINAL beneficiary is generally the executors or administrators of the Insured’s Estate. If, however, final rights are to be vested in someone other than the Insured (such as a spouse), the FINAL beneficiary is generally the executors or administrators of that person (surviving beneficiary).

Section 2. Designation of Rightsholder (Owner)

First Review Your Beneficiary Designation. Do you want to complete Section 1 in addition to Section 2?

To change the rightsholder (owner) on your policy, check the appropriate box. If rights are to be transferred to someone other than the Insured, complete 2. A and B. (See sample wordings on Page 2.)

Section 3. Signatures

To sign on behalf of a corporation:

1.An officer other than the Insured and other than the secretary must sign and the signing officer must specify his/her corporate title.

2.If the only two officers in the corporation are the Insured and the secretary, please submit a statement to that effect or indicate that fact in Section 3. See below for additional signature requirements:

Professional Corporation ("PC")

Officer or Shareholder. Prefer someone who is both.

Registered Limited Liability

 

Partnership ("R.L.L.P.")

Partner

Limited Liability Company ("L.L.C.")

Member or Manager. Any other person would have to approve his/her

 

authority under its opening agreement of Articles of Organization.

Professional Service L.L.C. ("P.S.L.L.C.")

Same as L.L.C.

3.State the complete legal name of the Corporation as it appears in your Charter or Certificate of Incorporation. DO NOT use the corporate assumed name alone (its d/b/a).

4.The final beneficiary and/or rightsholder (owner) will be the Corporation’s successors or assigns.

To sign for a partnership:

1. A general partner other than the insured must sign in the following manner: (state full name of the partnership)

by:

. A limited partner may not sign for a partnership.

(member of the firm)

2.The final beneficiary and/or rightsholder (owner) will be the Partnership’s successors or assigns. To sign on behalf of a tax-qualified plan:

1.The qualified trustee(s) must sign in the capacity of "trustee", of the qualified/tax-sheltered plan, not individually.

2.State the full name of the tax-qualified plan as it appears in the plan.

GENERAL

A proposed Beneficiary Must Sign if designated to receive "as interest may appear" or in any way indicating the rightsholder’s (owner’s) indebtedness to the beneficiary, when that rightsholder is retaining any rights which would enable him at any time to eliminate the interest of the proposed beneficiary.

IMPORTANT: PLEASE READ THIS SPECIAL INSTRUCTION SHEET BEFORE COMPLETING THE FORM.

(Page 2 of 5)

SAMPLE WORDINGS

If you need help in wording a designation or if your designation is too long for this form, send us details of the change desired and we will prepare the form for you based on our interpretation of the information, it will then be subject to your approval.

SAMPLE WORDINGS FOR COMPLETING FIRST AND SECOND BENEFICIARY DESIGNATIONS IN SECTION 1.

If you wish to designate . . .

SINGLE BENEFICIARY

aperson Insured’s estate corporation partnership

GROUP (more than one person) BENEFICIARY children

parents

named brothers and sister

(nieces and nephews, aunts and uncles, etc.)

TRUST BENEFICIARY

Trustee under written trust (living trust)

Provide the names of Trustee(s), the name of living trust, date of living trust, the name(s) of grantor(s). If all identifying trust information is not provided, a Statement as to Trustee/ Beneficiary Form 3559 will be required.

Testamentary Trust (Trust created in a Will) The terms of trust must be fully contained in the Will and the Will must be probated to effectuate the trust.

Please use this language . . .

—Spouse, Jane Doe

—Insured’s executors or administrators

—XYZ Corporation, or its successors or assigns.

—Smith and Jones, a partnership, or its successors or assigns.

—children, John Doe, Susan Doe and Frank Doe (will not include any other children)

—children of Insured including John Doe, Susan Doe and Frank Doe

—children of marriage of Insured and spouse, Mary Doe

—children of marriage of Insured and spouse, Mary Doe, including John Doe and Susan Doe

—Father, James Doe and mother, Frances Doe

—Sister, Jane Doe, and brothers John Doe, Frank Doe.

—John Jones (XYZ Bank) as trustee or his (its) successor trustee under an Agreement dated May 1, 1978 made by and between the Insured and said trustee.

—the trustee or successor trustee under a trust created under the Instrument probated as the Last Will and Testament of the Insured or, if the Insured shall die intestate or shall leave a will not creating a trust, the

Insured’s executors or administrators.

NOTE: If your Will specifies that some portion (or all) of your estate must be distributed ("poured over") to a trust that is already in existance, (a living trust), then you can designate the trustee under the written trust agreement as the beneficiary, you need not designate the executor or a trustee under a testamentary trust.

SAMPLE WORDINGS FOR COMPLETING RIGHTSHOLDER (OWNER) DESIGNATIONS

IN SECTION 2.A and 2.B, IF APPLICABLE.

If you wish to designate . . .

SINGLE RIGHTSHOLDER

aperson corporation partnership

TRUST RIGHTSHOLDER

Usually no other rightsholder, and no FINAL rightsholder, needs to be named after this (an irrevocable trust) designation; but, if there is a need to do so, (a revocable trust) complete the FINAL rights (Section 2B) or send us full details and we will propose a designation for you.

Please use this language . . .

—Jane Doe, spouse

—XYZ Corporation, or its successors or assigns.

—Smith and Jones, a partnership, or its successors or assigns.

—John Jones (or XYZ Bank) as trustee or his (its) successor trustee under an Agreement dated May 1, 1978 made by and between the Insured and said trustee.

GROUP (more than one person) RIGHTSHOLDER

Group rightsholders must act jointly and ownership interests cannot be apportioned.

children

— Insured’s children

 

— children, Jane Doe, John Doe and Mary Doe

 

— children of marriage of Insured and spouse, Mary Doe

 

— children of marriage of Insured and spouse, Mary Doe, including John

 

Doe and Susan Doe

parents

— Mother, Jane Doe and Father, James Doe -OR-

 

Mother and Father of Insured, Jane and James Doe, respectively.

Continued Next Page ..........

(Page 3 of 5)

SAMPLE WORDINGS CONTINUED ..........

SINGLE PRIMARY RIGHTSHOLDER AND SINGLE CONTINGENT RIGHTSHOLDER

spouse, followed by child

— Spouse, Mary Doe, if living, if not, daughter, Jane Doe

SINGLE PRIMARY RIGHTSHOLDER AND GROUP CONTINGENT RIGHTSHOLDER

spouse, followed by unnamed children

— Spouse, Mary Doe, if living, if not, Insured’s children

spouse, followed by named children

— Spouse, Harry Doe, if living, if not, son, Frank Doe and daughter, Jane Doe

GROUP PRIMARY RIGHTSHOLDERS AND SINGLE CONTINGENT RIGHTSHOLDER

children, followed by spouse

— Insured’s children, if none is living, spouse, Mary Doe

YOU MAY USE THIS FORM:

To change either the beneficiary or the rightsholder (or both).

For any number of policies, provided you are requesting an identical change for each policy.

To change the beneficiary for proceeds payable at the Insured’s death only for Family Plan policies issued prior to 1968. The beneficiary of the proceeds payable upon the death of the insured wife and insured children will remain as stated in the policy or previous family plan endorsement.

You may NOT use this form:

To change the beneficiary on any MONY Employee or FU Pension or Benefit Plans, Disability Insurance Policies. Send us details of changes required for such policies and we’ll prepare a request for the rightsholder’s signature.

For settlement options on non - qualified policies. Use BENEFICIARY, RIGHTS and SETTLEMENT OPTION REQUEST (Form 4113), which may be obtained from your MONY Field Underwriter. (Settlement Options are not available on qualified policies.)

-OR-

To release an assignment. Assignment of Policy/Release of Assignment (Form 3600) is required and may be obtained from your MONY Field Underwriter.

TAX CONSEQUENCES

An attorney should be consulted about possible tax consequences in the following instances:

(a)if the rightsholder is not the Insured and is not the beneficiary; (b) if the rightsholder designates joint rights to two or more individuals, as a gift; (c) if the rightsholder is a corporation and is not a beneficiary; (d) if rights are changed on an annuity issued after April 22, 1987; (e) a transfer to a person two or more generations younger than the transferor (generation skipping); (f) if the policy has a loan and the rights are being transferred as a gift.

INFORMATION ON DIVORCE

If you are required to designate an ex-spouse or children as beneficiary(ies) pursuant to a divorce decree or order, then the decree should be submitted to us. We will try to conform the beneficiary designation to the terms of the decree. An endorsement will be sent to you and will be deemed to be accepted by you unless you notify us of your rejection. If you currently have your ex-spouse listed as beneficiary, then you should either change the beneficiary to reflect your new choice of beneficiary or to reconfirm your desire to designate the ex-spouse despite the divorce. In most states, a divorce does not automatically extinquish the rights of an ex-spouse as beneficiary. Therefore an Insured who inadvertently leaves his/her ex-spouse as beneficiary after a divorce may cause payment of the death benefits to the ex-spouse even though such payment is contrary to his/her intent. If your ex-spouse is the beneficiary and you do not want him/her to be a beneficiary, then you should submit a change of beneficiary request.

MONY Life Insurance

MONY Life Insurance

TITLE CHANGE FORM

Company

Company of America

(RIGHTS, BENEFICIARY,

P.O. Box 4830

P.O. Box 4720

METHOD OF PAYMENT)

Syracuse, NY 13221

Syracuse, NY 13221

(Page 4 of 5)

 

(Not licensed in WY and NY)

Form No. 10481 (Rev. 11/2006)

Agency

Code

Policy Numbers

Insured’s Name (as it appears on policy)

If Insured’s name has changed, state new name and reason for change : _________________________________________________________________

Joint beneficiaries will receive equal shares proportionate to the number of those beneficiaries who survive the Insured. Proceeds will be payable in one sum.

1. FIRST

 

Are any named beneficiaries a Viatical or Life Settlement Company?

o Yes

o No

 

BENEFICIARY(IES)

 

 

 

 

 

 

 

 

 

 

 

 

if living, if not

________________

_________________________________________

_________________________________

 

 

(Relationship(s)

 

(Names of First Beneficiary(ies)

 

 

(Date(s) of Birth)

Please type or print full

____________________________________________________________________________________________________

name and indicate the

 

 

 

 

 

 

 

 

 

 

 

 

relationship to the

____________________________________________________________________________________________________

insured person

Beneficiary(ies) Address:

 

 

 

 

Beneficiary(ies) Social Security # :

 

 

 

 

2. SECOND

________________

_________________________________________

_________________________________

BENEFICIARY(IES)

(Relationship(s)

 

(Names of Second Beneficiary(ies)

 

 

(Date(s) of Birth)

if living, if not

____________________________________________________________________________________________________

Please type or print full

____________________________________________________________________________________________________

name and indicate

Beneficiary(ies) Address:

 

 

 

 

Beneficiary(ies) Social Security # :

relationship to the

 

 

 

 

 

 

 

 

 

 

 

 

insured person.

 

 

 

 

 

 

 

 

 

 

 

 

FINAL

 

If no beneficiary named above is living at the Insured’s death, the beneficiary is the Insured’s executors or administrators,

BENEFICIARY

unless checked:

 

 

 

 

 

 

 

 

 

 

 

 

¨ The executors or administrators of the survivor of all beneficiaries (the last designated beneficiary to die)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. RIGHTS

 

 

 

 

 

 

 

 

 

 

 

 

 

Rightsholder,

Is the new owner a Viatical or Life Settlement Company? o Yes

o No

 

 

Contract

 

 

 

 

 

 

 

 

 

 

 

 

 

holder (Owner) on

Please change the Policy(ies) so that all rights provided in “Rights (Ownership) Under Policy” (refer to #5 on Page 5) belong

record remains

exclusively to:

 

 

 

 

 

 

 

 

 

 

unchanged Unless

 

 

 

o The Insured / Annuitant

 

 

 

 

 

this section is

One box

a.

 

¨ The person(s) whose full name(s), relationship(s) and address(es) is/are:

completed.

Must be

 

 

____________________________________________________________________________________

 

 

Checked

 

 

____________________________________________________________________________________

Where two or more

 

 

 

____________________________________________________________________________________

Rightsholders are

One box

b.

 

FINAL RIGHTSHOLDER (IF ALL PERSONS DESIGNATED IN a. PREDECEASE THE INSURED):

Designated, those

Must be

 

 

¨ The Insured / Annuitant

 

 

 

 

 

Living shall act jointly

Checked

 

 

¨ The executors and administrators of the rightsholder, if two or more rightsholders, the

Unless otherwise

 

 

 

executors or administrators of the survivor of said rightsholders (the last to die).

indicated.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF AN

 

 

¨ The contractholder’s spouse. (SEE NOTE)

 

 

 

IRS Form W-9 must be

ANNUITY

 

 

NOTE ON ANNUITIES: If the contract has a Contingent Annuitant Provision, and if the primary Annuitant

Completed by the

 

 

 

is the Contractholder at the time of death, the Successor Contractholder must be designated as the

NEW RIGHTSHOLDER

 

 

 

Primary Contractholder’s Spouse for the Contingent Annuitant Provision to continue the contract. At the

and Submitted to the

 

 

 

death of the Primary Contractholder, the contract MUST be surrendered and the proceeds paid out if the

Company with new

 

 

 

Contractholder’s Spouse DOES NOT then become the Contractholder.

 

Rightsholder’s

 

c.

 

If the policy(ies) provide for an endowment or life income at annuity commencement. The right to receive

Taxpayer Identification

 

 

 

such endowment or life income at annuity commencement belongs exclusively to the Insured/Annuitant.

Number.

 

 

 

 

 

 

 

 

 

 

 

 

 

3.SIGNATURES The undersigned Rightsholder (Owner) requests the Company to accept and record the designations above, to add the provisions on

page 5 of this form his/her/its policy/contract (if necessary to update it), to issue an endorsement consistent with the above designations or to accept this

form as an endorsement (whichever it deems appropriate), and to accept any material changes above that I have initialed or otherwise ratified. If signing

on behalf of a corporation or partnership, see "Instructions" Page 1, Section 3 - "Signatures".

 

 

 

Signature _________________________________________

Witness ____________________________________ Date___________________

of Owner

FIRST NAME

INITIAL

 

LAST NAME

 

 

If Rightsholder (Owner) resides in Massachusetts, a Witness is mandatory

 

 

 

 

 

 

 

 

and a named beneficiary may not be a witness.

Additional _______________________________________________

FOR HOME OFFICE USE:

 

 

Signature

FIRST NAME

INITIAL

 

LAST NAME

 

 

Form Recorded and Endorsement Waived

MONY Life Insurance Company

 

 

 

 

 

 

 

Date_________________

By__________________________________

 

 

 

 

 

For Agency Use Only: ¨ Pending Transaction: contact

¨ Policyowner

¨FU

¨ Agency

F.U. Full Address if not at Agency of Record

 

¨ Completed Transaction: contact

¨ Policyowner

¨ FU

¨ Agency

____________________________________

Print F.U. or ASA Name ____________________________________

 

 

 

 

____________________________________

GENERAL PROVISIONS

(Page 5 of 5)

1.DEFINITIONS

(a)"WE", "US", "OUR" and "Company" refer to The MONY Life Insurance Company or any of its insurance subsidiaries.

(b "insured wife" and "insured child" —For family plan policies, wherever these words appear in this form, the section of the Policy entitled "definition of insured wife and insured child" will also apply to any endorsement.

3.TRUST PROVISIONS IN LIVING TRUSTS AND WILLS

A written trust or will cannot change the terms of your policy or otherwise bind the Company. Further, the Company cannot determine at any time whether a trust or will is valid. Accordingly, the Company cannot assume any responsibility for the trustee’s performance or failure to perform any trust duties and the Company will not have any further obligations under a policy if it has made a payment to (or honored a specific request by) a trustee.

(c)HOME OFFICE. Our Operations Center in Syracuse, New York and our World Headquarters in New York, New York are included within the meaning of Home Office.

(d)RELATIONSHIPS. All relationships used in the beneficiary and rights designations refer to the Insured unless otherwise indicated.

(e)"Policy", "Insured" and "Policyholder". For annuities, wherever these words appear in this form, they mean "Contract", "Annuitant" and "Contractholder", respectively. For Group Universal Life, whenever Policy and Policyholder appear in this form they mean Certificate and Certificateholder, respectively.

f)RIGHTSHOLDER (OWNER) A person who can exercise rights is a rightsholder. In contrast, a person designated as contingent rightsholder can only act upon the death of the primary rightsholder and is not considered a rightsholder until the happening of that event. Wherever "Rightsholder" appears on this form, it means "Rightsholder", "Owner" and "Policyholder".

2.DETERMINATION OF BENEFICIARY. The beneficiary in Section 1 will become entitled to the amount payable (proceeds) in the order and proportion stated. For proceeds payable at the Insured’s death:

Payment made in one sum: Unless otherwise stated, a beneficiary will not be considered "living" unless the beneficiary is living on the earlier of (a) the day due proof of the Insured’s death is received by us at our Home Office and (b) the 14th day after the Insured’s death. The share of the death proceeds of any beneficiary who is not living on the earlier of these two dates will be payable to the remaining beneficiaries in the manner provided.

4. POLICY ASSIGNMENT

The interest of any beneficiary or other person will be subordinate to any assignment whenever made. We may rely solely on the assignee’s statement as to the amount of its interest in the death benefit proceeds, which will be payable in one sum.

5. RIGHTS (OWNERSHIP) UNDER POLICY

Subject to the rights of any assignee, during the Insured’s lifetime and prior to the date of any endowment proceeds or life income at maturity becoming payable, the right to change the beneficiary, the right to assign, the right to receive any endowment proceeds or life income at maturity or to change the payee thereof, and all other rights, benefits, options, and privileges conferred by the Policy or allowed by the Company belong exclusively as designated in the application for this Policy unless otherwise provided by endorsement or as designated in Section 2 on Page 4.

6.CHANGES IN BENEFICIARY AND RIGHTSHOLDER (OWNER)

These changes may be made during the Insured’s lifetime by written request to us at our Home Office. The Policy need not be presented for endorsement unless requested by us. Any such change will take effect as of the date the notice was signed, upon acceptance and recording at the Home Office, subject to any payment made by us or action taken by us before receipt of the request at our Home Office.

7.SETTLEMENT OPTIONS

Use BENEFICIARY, RIGHTS AND SETTLEMENT

OPTION REQUEST (Form 4113) which may be obtained from your MONY Field Underwriter. (Settlement Options are not available for Qualified policies).

FOR HOME OFFICE USE ONLY

Endorsement No.

 

 

 

Endorsement to Agency

DO NOT DESTROY

PD 99

10481

 

 

Endorsement sent to

 

 

 

 

10660

12388

 

 

 

 

 

 

 

 

File with App #

 

 

PI 10

 

 

 

Policy/Statement Returned

 

 

 

 

11330 LA

12491

 

Agy

 

 

 

 

 

 

Servicer’s Name

 

11197 LA

BART

 

 

 

FU #

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Part no. 1 of filling out mony life insurance beneficiary forms

2. Now that this segment is completed, you have to insert the essential details in A general partner other than the, member of the firm, A limited partner may not sign, The final beneficiary andor, To sign on behalf of a taxqualified, The qualified trustees must sign, A proposed Beneficiary Must Sign if, GENERAL, and IMPORTANT PLEASE READ THIS SPECIAL allowing you to proceed further.

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3. Through this part, take a look at Agency Code, Policy Numbers, Insureds Name as it appears on, If Insureds name has changed state, PRIMARY BENEFICIARYIES if living, Please type or print full name and, CONTINGENT BENEFICIARYIES if, FINAL BENEFICIARY, To be completed for change of, Rightsholder Contract holder Owner, Are any named beneficiaries a, Relationships, Names of First Beneficiaryies, Dates of Birth, and Phone number. All of these need to be completed with greatest accuracy.

Guidelines on how to prepare mony life insurance beneficiary forms stage 3

4. The next part comes with all of the following blanks to consider: Rightsholder Contract holder Owner, Where two or more Rightsholders, IRS Form W must be Completed by, InsuredAnnuitant, Is this ownership change in, Soc Sec TIN IRS Form W signed by, Full Name of Proposed, Individual Trust Partnership, Account Number, Date of Birth, FINAL RIGHTSHOLDER IF ALL PERSONS, IF AN ANNUITY, The Insured Annuitant Final, executors or administrators of the, and NOTE ON ANNUITIES If the contract.

Is this ownership change in, The Insured Annuitant Final, and NOTE ON ANNUITIES If the contract of mony life insurance beneficiary forms

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mony life insurance beneficiary forms conclusion process described (stage 5)

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