State Farm Life Insurance Beneficiary Change Form Details

Are you about to make a change to your life insurance policy or beneficiary designation? If so, be sure to use the State Farm change of beneficiary form. This form makes it easy for you to update your policy as needed, and ensures that your beneficiaries receive the benefits they're entitled to. Make sure to submit the form in a timely manner, so that your loved ones can receive the support they need when you're no longer able to provide it.

We've collected some technical facts about the state farm change of beneficiary form. You might want to look at it before completing the gaps.

QuestionAnswer
Form NameState Farm Change Of Beneficiary Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesstate farm life insurance forms, state change beneficiary form, state farm life insurance change of beneficiary form, state farm beneficiary change form

Form Preview Example

Designation or Change of Beneficiary Request

State Farm Mutual Funds® Individual Retirement Accounts, Tax Sheltered Accounts (TSA)

under 403(b)(7), or Archer Medical Savings Accounts (MSA).

This form is used to designate or change the Beneficiary(ies) of your Traditional IRA, Roth IRA, SEP IRA, SIMPLE IRA, TSA, or MSA. If you wish to establish a transfer on death beneficiary on your non-tax qualified State Farm Mutual Fund account, please call and request a Designation or Change of Transfer on Death (TOD) Beneficiary Form.

By completing this form you revoke any prior death beneficiary designation and name the following as the beneficiary(ies) of this account, subject to your right to change this designation as provided in the applicable Custodial Account Agreement.

If you have any questions or need additional information before completing this form, please call 1-800-447-4930.

1 Instructions

1.This form is deemed valid by the Custodian if the following requirements have been met:

a)The beneficiary information is complete.

b)It is signed and dated by the Participant.

c)Your spouse/partner has signed the form - if required.

d)It is filed with the Custodian prior to your death.

2.To name more than four primary or secondary beneficiaries:

a)Attach a separate page and include, for each beneficiary, all of the information requested on this form. Have your spouse/partner sign the page, if required.

b)Sign and date the additional page.

c)Have your spouse/partner sign the page, if required.

3.See the applicable State Farm Mutual Funds Custodial Account Agreements for additional provisions.

2 Participant Information

First Name

MI

Last Name

Address

Social Security Number

City

Account Number

 

State

 

ZIP Code

 

 

 

 

 

Telephone Number

Marital Status

 

 

 

Single

Married

 

 

 

 

 

3 Designation of Beneficiary

(PRIMARY BENEFICIARY(IES)

Name

SSN/TIN

Relationship

Date of Birth

 

% of Account

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

Street

 

City

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

SSN/TIN

Relationship

Date of Birth

 

% of Account

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

Street

 

City

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

SSN/TIN

Relationship

Date of Birth

 

% of Account

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

Street

 

City

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

SSN/TIN

Relationship

Date of Birth

 

% of Account

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

Street

 

City

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total = 100%

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(SECONDARY BENEFICIARY(IES)

Name

SSN/TIN

Relationship

Date of Birth

 

% of Account

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

Street

 

City

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

SSN/TIN

Relationship

Date of Birth

 

% of Account

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

Street

 

City

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

SSN/TIN

Relationship

Date of Birth

 

% of Account

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

Street

 

City

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

SSN/TIN

Relationship

Date of Birth

 

% of Account

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

Street

 

City

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total = 100%

4 Signature(s)

Participant's Signature

Date

Signature of Spouse/Partner (if required*)

*Note: Spouse or partner's signature is required if the spouse/partner is not the sole primary beneficiary for this account and the spouse/partner and/or Participant resides in Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington or Wisconsin. By signing, the spouse/partner voluntarily and irrevocably consents to the beneficiary designation set forth above and waives all rights he/she may have with respect to the account, except for any rights provided under the applicable Custodial Account Agreement.

Please fax or mail all signed completed forms to: State Farm Mutual Funds

P.O. Box 219548

Kansas City, Missouri 64121-9548

FAX: 1-816-471-4832

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