Western Form Change Beneficiary – Fill Out and Use This PDF

The Western Change Beneficiary form is a crucial document for policyholders looking to update the beneficiary designations on their insurance policies. This form allows for the designation of both primary and contingent beneficiaries, ensuring that policy proceeds are distributed according to the policy owner's wishes. Before proceeding, it’s important to understand key requirements such as the need for original owner signatures, clear marking of beneficiaries as primary or contingent, and the necessity of total percentages equalling 100% for both beneficiary types.

To simplify this process and ensure your wishes are accurately recorded, click the button below to fill out the form.

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Western Form Change Beneficiary PDF Details

Navigating the process of updating the beneficiaries on your insurance policy or financial accounts is a crucial task that often requires meticulous attention to detail. The Western Change Beneficiary form serves as a valuable tool in this process, offering a structured way for policyholders to modify who will receive the proceeds of their insurance policy upon their death. This form is comprehensive, demanding precise inputs such as signature verifications, clear demarcation between primary and contingent beneficiaries, and adherence to percentages totaling 100% for both beneficiary categories. Users are advised to carefully follow the instruction sheet to avoid common pitfalls, such as the inadvertent revocation of previously named beneficiaries due to partial completion or incorrect filling of the form. It goes further to accommodate different scenarios, allowing for individual, trust, or estate designations among others. The importance of legibility and compliance with the company's requirements is emphasized, underscoring the need for accuracy to ensure that the policy owner's wishes are executed as intended. Furthermore, special attention is given to the designations of irrevocable beneficiaries, given their vested interest in the policy, which restricts the policy owner's ability to make changes without consent. Additionally, the document touches on legal considerations pertinent to residents of community property jurisdictions, suggesting policyholders might need to consult with legal or tax advisors before making certain beneficiary changes. Such comprehensive instructions underscore the complexity and significance of accurately completing the Western Change Beneficiary form, ensuring that in times of transition, the financial benefits are directed according to the policy owner's precise wishes.

Question	Answer
Form Name	Western Form Change Beneficiary
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	STIRPES, Edgewood, ies, PS00116

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CHANGE OF BENEFICIARY REQUEST INSTRUCTION SHEET

The following information must be provided on the Beneficiary Change form

Before completing the Beneficiary Change form please read these important instructions carefully:

Original owner’s signatures and date are required – Faxes will be accepted

A Primary beneficiary is always required. Primary or contingent must be clearly marked. One person cannot be both a primary and contingent beneficiary. All prior beneficiaries will be revoked if we receive complete information for each section. Example: If only the primary beneficiary designation section is complete, but the contingent beneficiary designation section is incomplete, we will only process the primary beneficiary designation section and reject the contingent beneficiary designation section. No change was done to the incomplete beneficiary designation section.

The contingent beneficiary section is to be completed even if it is to only restate the current contingent beneficiaries on the policy. (Failure to do so will result in any current contingent beneficiaries being removed).

Do not use decimals or fractions. Enter whole percentages only.

If designating more than one beneficiary, the percentages must total 100% for the primary and 100% for the contingent beneficiaries.

If naming a trust as beneficiary please include the trust date and include the Trustee Certification form.

All requests must be legible and in good order.

The Company reserves the right to refuse to record any change requests not meeting the Company’s requirements.

_____________________________________________________________________________

Example of Beneficiary Designations

ONE BENEFICIARY:

Primary: Jane Doe, Wife, 100%

Contingent: None

ONE PRIMARY AND ONE CONTINGENT:

Primary: Jane Doe, Wife, 100%

Contingent: John Doe, Jr., Son, 100%

INSURED’S ESTATE:

Primary: The Estate of the insured

TRUST:

Primary: Jane Doe Trust Dated mm/dd/yyyy

The company shall not be responsible for the disposition by the trustee of any proceeds paid to the trust.

TRUST UNDER LAST WILL AND TESTAMENT: (Should the Insured die intestate or if no trust is created, then reverts to the Insured’s estate.)

Primary: The last will, last will and testament, testamentary trust, or trust created under the will.

SPOUSE OF INSURED OTHERWISE CHILDREN:

Primary: Jane Doe, Wife, 100%

Contingent: Any children born of the marriage of the Insured and said wife (living children must be named)

Primary: Jane Doe, Wife

Contingent: John Doe, Jr., Son and any other children of the Insured (living children must be named)

TWO BENEFICIARIES IN UNEQUAL AMOUNTS: Primary: Jane Doe, Mother, 75%; John Doe, Brother, 25%

PER STIRPES DESIGNATIONS:

Generally used to direct death benefit to lineal descendants (i.e. all children of Jane Doe and John Doe in equal shares, per stirpes).

WRL does not give legal advice. You may wish to seek legal counsel prior to making changes

or using per stirpes designations.

INDIVIDUAL CREDITOR:

Primary: John Doe, Creditor, as his interest may appear, if living, otherwise to the creditor’s estate as their interest may appear, remainder, if any, to Jane Doe, Wife.

CORPORATE CREDITOR:

Primary: ABC Co., Inc., Creditor of the Insured, a California Corporation, its successors and assigns, as its interest may appear, remainder, if any, to Jane Doe, Wife

IRREVOCABLE BENEFICIARY:

Primary: Jane Doe, Former Wife of the Insured, irrevocably designated.

Minor: Jane Doe Irrevocable

Guardian must sign in capacity and provide a copy of current document.

Please Note: Irrevocable Beneficiary’s signature is required for any change or distribution. Please review the laws of your state

___________________________________________________________________________________________

PS00116COV –11/10

FL-CS

CHANGE OF BENEFICIARY REQUEST (Primary Beneficiary Changes)

Western Reserve Life Assurance Co. of Ohio	Transamerica Life Insurance Company
4333 Edgewood Rd. NE, Cedar Rapids, IA 52499		4333 Edgewood Rd. NE, Cedar Rapids, IA 52499
Phone Number (800) 851-9777 Fax Number: (727) 299-1620		Phone Number (800) 322-7164 Fax Number (727) 299-1620

POLICY NUMBER(S)_________________________________OWNER __________________________________________________________

INSURED __________________________________________ JOINT OWNER (IF ANY) ____________________________________________

PLEASE NOTE:

If the primary beneficiary designation section is in good order, it will revoke previous primary beneficiary designations.

Primary and Contingent beneficiary(ies) need to be restated even if they are not being changed.

Example: If you are changing only the primary beneficiary(ies), you must restate the contingent beneficiary(ies).

Faxes will be accepted

Primary beneficiary(ies) will receive any proceeds payable at the insured’s death.

If no primary beneficiary(ies) survives the insured, the contingent beneficiary(ies) will receive any proceeds.

If no beneficiary(ies) survive the insured, any proceeds will go to the owner’s estate

PRIMARY BENEFICIARIES (REQUIRED)

Date of Birth

Percentage

Relationship to

Section A

or Trust date

(for multiple

Insured

beneficiaries)

Name_______________________________________

□share equally

Address_____________________________________

________%

whole

number

only, no decimals or

Social Security #______________________________

fractions

Name_______________________________________

□share equally

Address_____________________________________

________%

whole

number

only, no decimals or

Social Security #______________________________

fractions

Name_______________________________________

□share equally

Address_____________________________________

________%

whole

number

only, no decimals or

Social Security #______________________________

fractions

Name_______________________________________

□share equally

Address_____________________________________

________%

whole

number

only, no decimals or

Social Security #______________________________

fractions

Name_______________________________________

□share equally

Address_____________________________________

________%

whole

number

only, no decimals or

Social Security #______________________________

fractions

Total 100%

If more than one primary or contingent beneficiary is designated, proceeds will be divided equally among

survivors within the class unless otherwise indicated.

Please print clearly using blue or black ink.

_______________________________________________________________________________________________

PS00116 – 11/10

Pg 1 of 3

FL-CS

CHANGE OF BENEFICIARY REQUEST (Contingent Beneficiary Changes)

POLICY NUMBER(s)__________________________________OWNER ______________________________________________

____________________________________________________JOINT OWNER (IF ANY) ___________________________________

PLEASE NOTE:

If the Contingent Beneficiary designation section is in good order, it will revoke previous contingent beneficiary designations.

Contingent and Primary beneficiary(ies) need to be restated even if they are not being changed.

(Failure to do so will result in any current contingent beneficiaries being removed).

Example: If you are changing only the contingent beneficiary(ies), you must restate the primary beneficiary(ies).

Faxes will be accepted

Primary beneficiary(ies) will receive any proceeds payable at the insured’s death.

If no primary beneficiary(ies) survives the insured, the contingent beneficiary(ies) will receive any proceeds.

If no beneficiary(ies) survive the insured, any proceeds will go to the owner’s estate

CONTINGENT BENEFICIARIES

Date of Birth

Percentage

Relationship to

Section B

or Trust date

(for multiple

Insured

beneficiaries)

Name_______________________________________

□share equally

Address_____________________________________

________%

whole

number

only, no decimals or

Social Security #______________________________

fractions

Name_______________________________________

□share equally

Address_____________________________________

________%

whole

number

only, no decimals or

Social Security #______________________________

fractions

Name_______________________________________

□share equally

Address_____________________________________

________%

whole

number

Social Security #______________________________

only, no decimals or

fractions

Name_______________________________________

□share equally

Address_____________________________________

________%

whole

number

only, no decimals or

Social Security #______________________________

fractions

Name_______________________________________

□share equally

Address_____________________________________

________%

whole

number

only, no decimals or

Social Security #______________________________

fractions

Total 100%

If more than one primary or contingent beneficiary is designated, proceeds will be divided equally among

survivors within the class unless otherwise indicated.

Please print clearly using blue or black ink.

_________________________________________________________________________________________________

PS00116 – 11/10

Pg 2 of 3

FL-CS

CHANGE OF BENEFICIARY REQUEST

Revocable Beneficiary: The owner may change a revocable beneficiary at any time without the beneficiary’s consent.

Irrevocable Beneficiaries: If a beneficiary is to be considered Irrevocable please indicate this next to the beneficiaries name. The owner may NOT change the irrevocable beneficiary without the consent of the irrevocable beneficiary. An irrevocable beneficiary has a vested interest in the proceeds of the policy; therefore, the policy owner cannot exercise certain rights without the permission of the irrevocable beneficiary.

If additional space is required please attach a separate page with all required information (i.e., Policy No., Owner’s signature and Date).

If any beneficiary is NOT a U.S. Citizen please indicate the country(ies) of citizenship_____________________________

________________________________________________________________________________________________

Signature of Owner ___________________________________________________	Date ________________________
	(Required)
___________________________________________________________________
Print Name / Title (POA, Trustee, Guardian, etc..)
Signature of Joint Owner /Partnership_____________________________________	Date ________________________
Signature of the Joint Owner is required for jointly owned policies.	(Required, if applicable)
Signature of Spouse __________________________________________________	Date ________________________
	(Required, if applicable)
Non-related witness___________________________________________________	Date ________________________

Signature of the Owner in Massachusetts must be witnessed by someone non-related and other than a named beneficiary. Must be over 18 years of age.

Signature of Irrevocable Beneficiary ______________________________________ Date ________________________


Signature of Irrevocable Beneficiary is required when designated.		(Required, if applicable)
Signature of Irrevocable Beneficiary	______________________________________ Date ________________________
Signature of Irrevocable Beneficiary is required when designated.		(Required, if applicable)
Signature of Irrevocable Beneficiary	______________________________________ Date ________________________
Signature of Irrevocable Beneficiary is required when designated.		(Required, if applicable)

This request may be mailed or faxed.

Please Note: If you reside(d) in one of the following community property jurisdictions (AZ, CA, ID, LA,NM, NV, TX, WA, WI, Puerto Rico and Guam), you may wish to consult with your legal or tax advisor prior to making changes to your policy.

FOR CORPORATIONS ONLY:

If the Owner is a corporation, complete the following corporate acknowledgement and submit a copy of the resolution of the Board of Directors authorizing execution of this Change of Beneficiary or complete the Entity Certification Form.

STATE OF _________________________ County of ________________________ on this ______ day of ______________, _______,

before me personally came ____________________________________, who being by me duly sworn, did depose and say that s/he

resides in _______________________________, that s/he is the _____________________________ of

_______________________________, the corporation described herein, and which executed this Change of Beneficiary; that s/he

knows the seal of said corporation; the seal affixed to said Change of Beneficiary is such corporation; that it was affixed by order of the Board of Directors; and that s/he signed her/his name thereto.

My commission expires___________________ Notary Public ___________________________________________________

_________________________________________________________________________________________________

PS00116 – 11/10

Pg 3 of 3

FL-CS

How to Edit Western Form Change Beneficiary Online for Free

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When it comes to fields of this specific document, this is what you need to do:

1. Fill out the POA with a selection of major fields. Note all of the information you need and ensure absolutely nothing is forgotten!

2. When this section is completed, go to type in the applicable details in all these: Name Address Social Security Name, or whole number only no decimals, share equally, or whole number only no decimals, share equally, or whole number only no decimals, share equally, or whole number only no decimals, share equally, and or whole number only no decimals.

or whole number only no decimals, or whole number only no decimals, and or whole number only no decimals of WRL

3. This next stage is straightforward - fill in all the fields in CHANGE OF BENEFICIARY REQUEST, PLEASE NOTE, If the Contingent Beneficiary, Contingent and Primary, Failure to do so will result in, Example If you are changing only, Primary beneficiaryies will, Faxes will be accepted, CONTINGENT BENEFICIARIES Section B, Date of Birth or Trust date, Relationship to, Insured, Percentage for multiple, share equally, and or whole number only no decimals to finish the current step.

Insured, Primary beneficiaryies will, and CHANGE OF BENEFICIARY REQUEST inside WRL

4. Completing share equally, or whole number only no decimals, share equally, or whole number only no decimals, share equally, or whole number only no decimals, share equally, or whole number only no decimals, Name Address Social Security Name, Name Address Social Security Name, and Total is crucial in this part - ensure that you don't hurry and fill out every single blank!

As for Name Address Social Security Name and share equally, ensure you review things in this current part. Both of these could be the most significant ones in this PDF.

5. The last step to complete this PDF form is crucial. You need to fill in the required blanks, such as Revocable Beneficiary The owner, Required if applicable, Required if applicable, Required if applicable, and Required, before finalizing. Otherwise, it may give you an unfinished and potentially nonvalid paper!

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Western Form Change Beneficiary – Fill Out and Use This PDF

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