Request For Change Of Beneficiary Form PDF Details

Are you searching for a way to modify or update your beneficiary designation? Knowing how to properly complete and follow through with the process of changing a beneficiary is essential in making sure that your last wishes are honored. In this blog post, we'll show you how to properly fill out and submit a Request For Change Of Beneficiary form. With the right information, doing so can be quick and easy - read on to find out more!

QuestionAnswer
Form NameRequest For Change Of Beneficiary Form
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namesallianz change of beneficiary form, allianz form download, allianz form print, allianz beneficiaries

Form Preview Example

Allianz Life Insurance Company of North America

PO Box 59060

Minneapolis, MN 55459-0060 Phone: 800.950.1962

Fax: 763.582.6006 allianzlife.com

Request to Transfer Ownership and/or Change Beneficiaries

The owner should use this form to transfer ownership of an annuity or life insurance policy, and/or to add or change beneficiaries.

Section 1: Policy or contract information

Policy or contract number:

Owner’s name:

INDIVIDUAL NAME OR NON-INDIVIDUAL NAME (E.G., TRUST, ESTATE, CHARITY)

Social Security number or EIN if owner is a trust or estate:

Phone number: (

 

)

 

Alternate number: (

 

)

Email address:

Complete only if you are transferring ownership:

Are you a U.S. citizen?

Yes

No - If no, indicate if you are a non-resident or resident alien:

Non-resident alien - complete IRS Form W-8BEN A non-resident alien is a lawful temporary resident in the U.S. Resident alien - complete IRS Form W-9 A resident alien is a lawful permanent resident in the U.S.

Section 2: New owner information

•The Transfer of ownership of a life or annuity contract generally has tax and legal implications. And once the ownership is effective, the tax reporting of the change cannot be reversed. Therefore, we encourage you to consult with your tax or legal advisor before making an ownership change.

•A change of ownership does not change your beneficiary. You may want to update the beneficiaries listed. See Section 3: Beneficiary designation.

•The new owner must also sign in Section 4: Signatures.

Individual name:

FIRST NAME

INITIAL

LAST NAME

Non-individual name (e.g., trust, estate, charity):

Social Security number or EIN if new owner is a trust or estate:

Street address (must not be a PO box):

STREET NUMBER, STREET NAME (STREET ADDRESS IS REQUIRED AND MUST BE YOUR PERMANENT PRIMARY RESIDENTIAL ADDRESS)

City:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State:

 

ZIP code:

 

 

Phone number: (

)

 

 

 

 

 

 

Alternate number: (

)

 

 

 

 

 

 

Email:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of birth or date of trust:

 

 

 

 

 

 

Relationship to insured:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM

 

DD

 

YYYY

 

 

 

 

 

 

 

 

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(R-3/2015)

Policy or contract number:

(Please write your policy or contract number at the top of each page, in case the pages of this form become separated.)

Certification of Taxpayer Identification Number

If you are applying for this product and/or requesting payments as a U.S. Person, the IRS requires you to agree to the following statements. If you are not a U.S. Person, you are not eligible to apply for this product.

Under penalties of perjury, I certify that:

1. The Taxpayer Identification Number shown on this form is correct or I am waiting for a number to be issued to me.

If the IRS has notified you that you are currently subject to backup withholding because you failed to report interest and dividends on your tax return, you must cross out item 2 below.

2.I am not subject to backup withholding because:

a.I am exempt from backup withholding, or

b.I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of failure to report all interest or dividends, or

c.The IRS has notified me that I am no longer subject to backup withholding.

3.I am a U.S. person, and

4.The Foreign Account Tax Compliance Act (FATCA) code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

Additional documentation may be required

•If you are designating a trust as the new owner of a life insurance policy, please provide a complete copy of the trust, as well as a completed Trustee Certification form (NB2290). We will process your request once we receive the copy of the trust, and your completed form.

•If you are designating a trust on a nonqualified annuity contract, please provide a copy of the trust pages that include the name of the trust, the date of the trust, the names of the trustee and successor trustee, and signature page. You must also provide a completed Non-Individual Ownership form (NB6059). We will process your request once we receive the trust pages, and your completed form.

•If you are transferring ownership of a nonqualified annuity contract, you may incur a taxable event. In this case, we will

send the current owner an “Awareness of Taxation” letter to be completed. We will process your request once we receive your completed letter.

•Some ownership changes may result in a loss of certain benefits and coverages. In this case, we will send the current owner an “Awareness of Benefit Changes” letter. We will process your request once we receive your completed letter.

•Forms can be found at allianzlife.com

Section 3: Beneficiary designation

Complete this section to add or change beneficiaries.

•Percentages must total 100%.

•If you have more than 4 beneficiaries, please list them on a separate sheet, signed and dated by you.

•If you do not indicate the % you would like each beneficiary to receive, the surviving beneficiaries will share equally.

(continued on next page)

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Policy or contract number:

(Please write your policy or contract number at the top of each page, in case the pages of this form become separated.)

Beneficiary 1 Percentage:

 

%

Select one:

Individual beneficiary name:

 

 

 

Primary

Contingent

FIRST NAME

INITIAL

LAST NAME

Non-individual beneficiary name (e.g., trust, estate, charity):

Street address:

STREET NUMBER, STREET NAME

City:

 

Phone number: (

)

Email:

Date of birth or date of trust:

State:

 

ZIP code:

Alternate number: (

 

)

Social Security number or EIN:

Relationship to insured:

MM

DD

YYYY

Beneficiary 2 Percentage:

 

%

Select one:

Individual beneficiary name:

 

 

 

Primary

Contingent

FIRST NAME

INITIAL

LAST NAME

Non-individual beneficiary name (e.g., trust, estate, charity):

Street address:

STREET NUMBER, STREET NAME

City:

 

Phone number: (

)

Email:

Date of birth or date of trust:

State:

 

ZIP code:

Alternate number: (

 

)

Social Security number or EIN:

Relationship to insured:

MM

DD

YYYY

Beneficiary 3 Percentage:

 

%

Select one:

Individual beneficiary name:

 

 

 

Primary

Contingent

FIRST NAME

INITIAL

LAST NAME

Non-individual beneficiary name (e.g., trust, estate, charity):

Street address:

STREET NUMBER, STREET NAME

City:

 

Phone number: (

)

Email:

Date of birth or date of trust:

State:

 

ZIP code:

Alternate number: (

 

)

Social Security number or EIN:

Relationship to insured:

MM

DD

YYYY

(continued on next page)

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(R-3/2015)

Policy or contract number:

(Please write your policy or contract number at the top of each page, in case the pages of this form become separated.)

Beneficiary 4 Percentage:

 

%

Select one:

Individual beneficiary name:

Primary

Contingent

FIRST NAME

INITIAL

LAST NAME

Non-individual beneficiary name (e.g., trust, estate, charity):

Street address:

 

 

 

 

 

STREET NUMBER, STREET NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State:

 

ZIP code:

 

 

Phone number: (

 

)

 

 

 

 

 

 

 

Alternate number: (

 

 

)

 

 

 

 

 

 

Email:

 

 

 

 

 

 

 

 

 

 

 

 

Social Security number or EIN:

 

 

 

Date of birth or date of trust:

 

 

 

 

 

 

 

Relationship to insured:

 

 

 

 

 

 

 

 

 

 

MM

 

DD

YYYY

 

 

 

 

 

 

 

 

As the authorized signer, please sign your name and date below in the appropriate space. If you do not sign and date this page, we will not be able to process your request.

Changes will take affect based on the guidelines in your contract. Allianz is not liable for any requested changes we make to your contract before this effective date.

Current owner’s signature:

 

 

 

Signed date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM

 

DD

 

YYYY

Current joint owner’s signature:

 

 

 

Signed date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM

 

DD

 

YYYY

New owner’s signature:

 

 

 

Signed date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM

 

DD

 

YYYY

New joint owner’s signature:

 

 

 

Signed date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM

 

DD

 

YYYY

Trustee’s signature:

 

 

 

Signed date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM

 

DD

 

YYYY

as trustee of the:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TRUST NAME (PRINTED)

 

 

 

 

Attorney in fact signature:

 

 

 

Signed date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM

 

DD

 

YYYY

Power of attorney:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRINCIPAL NAME (PRINTED)

 

 

 

 

Assignee’s signature:

 

 

 

Signed date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM

 

DD

 

YYYY

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PAGE 4 OF 5

(R-3/2015)

Mailing addresses

 

Regular mail:

Overnight mail:

Allianz Life Insurance Company of North America

Allianz Life Insurance Company of North America

PO Box 59060

5701 Golden Hills Drive

Minneapolis, MN 55459-0060

Minneapolis, MN 55416-1297

Fax number: 763.582.6006

 

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(R-3/2015)

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This document will need some specific details; in order to ensure consistency, please take heed of the next tips:

1. When filling in the allianz request form, be sure to complete all of the needed blank fields within its relevant area. This will help to hasten the work, allowing your information to be handled without delay and correctly.

Stage number 1 in filling out allianz form print

2. Soon after filling out the previous part, head on to the subsequent step and fill out the essential details in these blank fields - The new owner must also sign in, Individual name, FIRST NAME, INITIAL, LAST NAME, Nonindividual name eg trust estate, Social Security number or EIN if, Street address must not be a PO box, STREET NUMBER STREET NAME STREET, City, State, ZIP code, Phone number, Alternate number, and Email.

allianz form print writing process detailed (stage 2)

Lots of people frequently get some points incorrect when filling out INITIAL in this area. You should definitely review everything you type in here.

3. Within this stage, have a look at Policy or contract number, Please write your policy or, Certification of Taxpayer, Under penalties of perjury I, The Taxpayer Identification, If the IRS has notified you that, I am not subject to backup, a I am exempt from backup, all interest or dividends or, c The IRS has notified me that I, I am a US person and, The Foreign Account Tax, reporting is correct, The IRS does not require your, and Additional documentation may be. Each one of these must be filled out with greatest accuracy.

Tips on how to prepare allianz form print stage 3

4. You're ready to proceed to this next portion! Here you'll have all these Policy or contract number, Please write your policy or, Beneficiary Percentage, Select one, Primary, Contingent, Individual beneficiary name, FIRST NAME, INITIAL, LAST NAME, Nonindividual beneficiary name eg, Street address, City, STREET NUMBER STREET NAME, and State empty form fields to complete.

allianz form print completion process described (portion 4)

5. As a final point, this final section is precisely what you have to wrap up prior to submitting the form. The blank fields you're looking at are the next: Beneficiary Percentage, Select one, Primary, Contingent, Individual beneficiary name, FIRST NAME, INITIAL, LAST NAME, Nonindividual beneficiary name eg, Street address, City, STREET NUMBER STREET NAME, State, ZIP code, and Phone number.

Completing section 5 in allianz form print

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