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.
| Question | Answer |
|---|---|
| Form Name | State Farm Change Of Beneficiary Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | state farm life insurance forms, state change beneficiary form, state farm life insurance change of beneficiary form, state farm beneficiary change form |
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
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 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
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3 Designation of Beneficiary
(PRIMARY BENEFICIARY(IES)
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Date of Birth |
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Total = 100%
1004549 |
104203.5 |
(SECONDARY BENEFICIARY(IES)
Name |
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Date of Birth |
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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
FAX:
1004549 |
104203.5 |