Unum Beneficiary Designation Form PDF Details

Making decisions about the future, especially those involving financial security and the well-being of loved ones, often requires careful planning and consideration. One key aspect of this planning involves the Unum Beneficiary Designation Form, a critical document for individuals who have Group Life and Group Accidental Death & Dismemberment Insurance through Unum Life Insurance Company of America, Provident Life and Accident Insurance Company, and The Paul Revere Life Insurance Company. This form allows policyholders to designate or change their beneficiaries—the people or entities that will receive insurance benefits in the event of the policyholder's death. It's imperative that this form be completed accurately, as it cancels all prior designations. Policyholders are guided to specify the beneficiaries clearly, including primary and contingent options, and detail the percentages of benefits to be allocated, ensuring these total 100%. It's also essential for policyholders to consider the implications of designating minors or trusts as beneficiaries, as special conditions may apply. Additionally, the form covers various types of coverage, including Basic Life, Supplemental Life, and AD&D, allowing for specific beneficiary designations for each if needed. Lastly, the form highlights the importance of regularly reviewing and updating beneficiary information to reflect current wishes, and suggests consulting an attorney for legal advice to ensure the designations are in line with the policyholder's intentions, underscoring the document's crucial role in one’s financial planning toolkit.

QuestionAnswer
Form NameUnum Beneficiary Designation Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesunum cs1110 form, unum beneficiary, unum designation form, unum group insurance form

Form Preview Example

BENEFICIARY DESIGNATION FORM

GROUP LIFE AND GROUP ACCIDENTAL DEATH

&DISMEMBERMENT INSURANCE

Unum Life Insurance Company of America Provident Life and Accident Insurance Company The Paul Revere Life Insurance Company

Instructions: Please complete, sign and date this form to designate your beneficiary(ies) or to change your existing beneficiary(ies). This form cancels all prior designations. If more than one beneficiary is named and no percentages are indicated, payment will be made to them in equal shares. If there are more than three (3) primary and/or contingent beneficiaries, please attach a separate sheet of paper. Return the completed form to your employer.

SECTION 1: Employee Information

Name (Last Name, Suffix, First Name, MI)

Social Security Number

Employer Name

Check the coverages listed below to which this beneficiary designation applies:

Basic Life Supplemental Life AD&D All

SECTION 2: Primary Beneficiary (ies)

I choose the person(s) named below to be the primary beneficiary(ies) of the Life Insurance benefits that may be payable at the time of my death. If any primary beneficiary(ies) is disqualified or dies before me, his/her percentage of this benefit will be paid to the remaining primary beneficiary(ies).

Name & Address

Relationship

Social Security

Number

Date of

Birth

Percentage

Total Must

Equal 100%

SECTION 3: Contingent Beneficiary (ies)

If all primary beneficiaries are disqualified or die before me, I choose the person(s) named below to be my contingent beneficiary(ies).

Name & Address

Relationship

Social Security

Number

Date of

Birth

Percentage

Total Must

Equal 100%

SECTION 4: Signature

X

________________________________

______________________________________________________________

Employee Signature

Date

Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

CS-1110 (12/09)

Important Information About Designation of Beneficiaries

Beneficiary Information

•Primary Beneficiary(ies) means the person(s) you choose to receive your life insurance benefits. Please specify the percentage of the benefit you want paid to each beneficiary; these percentages should total 100%. If any primary beneficiary is disqualified or dies before you, his/her percentage of the benefit will be paid to the remaining primary beneficiary(ies).

•Contingent Beneficiary(ies) means the person(s) you choose to receive your life insurance benefits only if all primary beneficiaries are disqualified or die before you. Please specify the percentage of the benefit you want paid to each beneficiary; these percentages should total 100%. If any contingent beneficiary is disqualified or dies before you, his/her percentage of the benefit will be paid to the remaining contingent beneficiary(ies).

•Minor Beneficiary(ies) – When you designate minors as beneficiaries, it is important to understand that insurance benefits may not be released to a minor child. They may, however, be paid to a court appointed guardian of the child’s estate. The regulations governing minor beneficiaries vary by state.

•Trust – You may designate a valid trust as a beneficiary.

Types of Coverage Information

•Basic Life is life insurance provided by your employer for which they pay the premiums.

•Supplemental Life is life insurance elected by you for which you pay the premiums.

•AD&D is Accidental Death & Dismemberment coverage.

•If you wish to designate different beneficiaries for any of the above coverages, please complete a separate form.

General Information

•Updates to Your Beneficiary Designation – You can change your beneficiary designation at any time. You may wish to review your designation periodically.

•Consult an Attorney – This information is not intended to be relied on as legal advice. You may wish to get the assistance of an attorney to help ensure your beneficiary designation correctly reflects your intentions.

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As for the fields of this precise form, here's what you need to do:

1. Whenever completing the unum beneficiary life insurance form, be certain to complete all of the essential blank fields within the corresponding section. This will help to hasten the work, allowing for your information to be handled efficiently and properly.

Completing part 1 in designation insurance form

2. Soon after completing this section, go to the subsequent step and fill in the necessary details in all these fields - Name Address, Relationship, Social Security, Date of Percentage, Number, Birth, SECTION Signature, Total Must Equal, X Employee Signature, Date, and Unum is a registered trademark and.

Name Address, Unum is a registered trademark and, and Total Must Equal of designation insurance form

It's very easy to get it wrong while filling out your Name Address, so make sure that you take a second look prior to deciding to submit it.

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