Western National Insurance PDF Details

Managing life insurance matters can often feel daunting, especially when it comes to navigating the various forms and requests pivotal to ensuring your policies reflect your current needs and wishes. The Western National Life Insurance Company Service Request form is a comprehensive document designed to facilitate a range of modifications to your annuity contracts or life insurance policies. From ownership transfers and beneficiary designations to providing updated personal information, this form serves as a key tool in the policy management process. Located at the heart of these operations in Amarillo, TX, Western National provides a straightforward avenue for policyholders to request changes such as assigning new owners, updating beneficiary details, changing personal information like names and addresses due to life events, and even requesting duplicate contracts. It emphasizes the importance of precise documentation, including the necessity for notarized or witnessed signatures to validate requests, underscoring the security measures in place to protect policyholder interests. This approach not only aims to streamline the administration of policy alterations but also enforces a layer of verification to maintain the integrity of each request.

QuestionAnswer
Form NameWestern National Insurance
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesANNUITANT, western national insurance, ANNUITIES, DESIGNATION

Form Preview Example

Western National

Life Insurance Company

Service Request

P.O. Box 871

Amarillo, TX 79105-0871

Telephone: 800.424.4990

Overnight Mailing Address

Annuity Administration

205 E. 10th Avenue

Amarillo, TX 79101-3546

POLICY NO.: ________________________________ OWNER'S DAYTIME PHONE NO.: ________________________________

ANNUITANT: ________________________________________ OWNER: _____________________________________________

 

 

ABSOLUTE

 

I/We hereby assign, transfer and convey all rights, title and interest in and to the subject contract to

 

 

 

 

 

ASSIGNMENT

1.

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

New Owner (Please print)

 

 

New Co-Owner, if any (Please print)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Transfer/Change of

 

 

 

 

 

.

 

 

Ownership)

 

Address of New Owner

 

 

 

Address of New Co-Owner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

New Owner’s Social Security Number

Owner’s Date of Birth

 

 

New Co-Owner’s Social Security Number Co-Owner’s Date of Birth

THE ORIGINAL CUSTOMER COPY OF POLICY/CERTIFICATE IS NEEDED TO COMPLETE YOUR REQUEST.

Original customer copy of policy is attached. (The contract/certificate will be endorsed and forwarded to the new Owner.)

PLEASE ATTACH

 

 

OR

 

 

I certify that the original customer copy of my policy/certificate has been lost or destroyed. After due search and to the

ANNUITY

 

 

CONTRACT

 

 

best of my knowledge, it is not in the possession or control of any other person. I understand that a duplicate policy

 

 

 

will be issued, endorsed and forwarded to the new Owner.

 

 

 

 

 

 

 

BENEFICIARY DESIGNATION FOR NEW OWNER

 

 

 

 

 

 

I/We revoke existing designations and make the following Primary and Contingent Beneficiary designations as listed

 

below. If the beneficiary is a Trust, please include the Name AND Date of the Trust.

 

If you wish to change the Annuitant’s beneficiary or Joint Owner’s, please complete Section 2 on the reverse side.

 

 

The New Owner’s Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

Primary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Beneficiary:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

Please Print Name, Relationship and Age of Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

Address, City, State and Zip Code of Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

Contingent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Beneficiary:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

Please Print Name, Relationship and Age of Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

Address, City, State and Zip Code of Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

Unless otherwise directed, proceeds payable will be divided equally among the surviving beneficiaries. The Company

 

shall not be liable for proceeds paid to a Trustee nor be required to determine that a trust is in effect. To determine the

 

existence or identity of the members of a designated class of beneficiaries, The Company may rely on such

 

documentation as it deems sufficient. If not stated otherwise, the right to change a beneficiary is reserved to the Owner.

 

 

 

 

 

 

 

 

 

 

 

 

TAXPAYER ID NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

TAX IDENTIFICATION NUMBER OF PRESENT OWNER: This section must be completed by the present

 

owner of the annuity. Failure to do so may delay your request.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRESENT OWNER’S TAX ID / Social Security Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: FOR ANNUITIES ISSUED AFTER APRIL 21, 1987, ANY GAIN AT TIME OF

 

 

TRANSFER WILL BE TAX REPORTED. IRS FORM 1099 WILL BE ISSUED AT YEAR END.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

Date

 

 

 

 

 

Signature Present Owner

 

 

 

Signature Present Co-Owner, if any

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

Date

 

 

 

 

 

 

Signature New Owner

 

 

 

Signature New Co-Owner, if any

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Irrevocable Beneficiary, if any

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: SIGNATURE(S) MUST BE NOTARIZED OR WITNESSED BY TWO ADULTS WHO ARE NOT NEW OWNER(S).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

Notary Public

 

 

 

 

 

 

 

Witness Signature

 

 

 

 

Witness Signature

ACKNOWLEDGMENT

When acknowledged by Company endorsement, the change shall take effect on the date this form was signed by Owner(s),

 

but without prejudice to The Company on account of payment made or action taken before the date of acknowledgment.

(For Home Office

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

Use Only)

 

 

 

 

 

Date of Acknowledgment

 

Authorized Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WNL 100 (6/09)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 1 of 2

Western National

Life Insurance Company

P.O. Box 871

Amarillo, TX 79105-0871

Telephone: 800.424.4990

Service Request

POLICY NO.: ________________________________ OWNER'S DAYTIME PHONE NO.: ________________________________

ANNUITANT: ________________________________________ OWNER: _____________________________________________

 

 

 

 

BENEFICIARY

 

 

I/We revoke existing designations and subject to any existing assignment, make the following Primary and Contingent

 

 

 

 

 

 

 

 

 

 

CHANGE

2.

 

Beneficiary designations as listed below:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**If the Beneficiary is being changed to a TRUST, please include the Name AND Date of the TRUST**

 

 

 

 

 

 

 

The Annuitant’s Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Primary Beneficiary:

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

Please Print Name, Relationship and Age of Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

Address, City, State and Zip Code of Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

Contingent Beneficiary:

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

Please Print Name, Relationship and Age of Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

Address, City, State and Zip Code of Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

The Joint Owner’s Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Primary Beneficiary:

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

Please Print Name, Relationship and Age of Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

Address, City, State and Zip Code of Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

Contingent Beneficiary:

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

Please Print Name, Relationship and Age of Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

Address, City, State and Zip Code of Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

The Owner’s Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Primary Beneficiary:

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

Please Print Name, Relationship and Age of Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

Address, City, State and Zip Code of Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

Contingent Beneficiary:

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

Please Print Name, Relationship and Age of Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

Address, City, State and Zip Code of Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

Unless otherwise directed, proceeds payable will be divided equally among the surviving beneficiaries. The Company

 

 

 

 

 

 

 

shall not be liable for proceeds paid to a Trustee nor be required to determine that a trust is in effect. To determine the

 

 

 

 

 

 

 

existence or identity of the members of a designated class of beneficiaries, The Company may rely on such

 

 

 

 

 

 

 

documentation as it deems sufficient. If not stated otherwise, the right to change a beneficiary is reserved to the Owner.

 

 

 

 

ADDRESS

 

 

Previous

 

 

 

 

 

 

 

 

 

 

 

Current

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CHANGE

3.

 

Address:

 

 

 

 

 

 

 

.

 

 

Address:

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME

 

 

 

Annuitant

 

 

 

Owner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CHANGE

4.

 

From:

 

 

 

 

 

 

 

 

 

 

 

To:

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ATTACH

 

 

Reason:

Marriage

Divorce

 

Other (explain below)

 

 

DOCUMENTATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DUPLICATE

 

 

I/We certify the subject contract has been lost or destroyed and request that a duplicate be issued. If a duplicate is issued,

 

 

 

 

 

 

 

 

 

 

CONTRACT

 

 

the original shall be null and void. The contract has not been sold, assigned or pledged to any person or organization.

 

 

 

 

 

 

 

 

 

 

REQUEST

5.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WITNESSED

 

 

 

 

 

 

 

ALL REQUESTS OR CHANGES REQUIRE WITNESSED SIGNATURE(S)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE(S)

6.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Complete This Section

 

 

 

 

 

Date

 

 

 

 

 

 

 

Witness Signature

 

 

Owner Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

For All Requests

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

Witness Signature

 

 

Co-Owner Signature

 

 

 

 

EXCEPT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

Ownership Changes.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

Witness Signature

 

 

Signature of Irrevocable Beneficiary, if any

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACKNOWLEDGMENT

When acknowledged by Company endorsement, the change shall take effect on the date this form was signed by Owner(s),

 

 

 

 

 

 

but without prejudice to The Company on account of payment made or action taken before the date of acknowledgment.

 

 

 

 

(For Home Office

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

Use Only)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Acknowledgment

 

 

 

 

Authorized Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WNL 100 (6/09)

Page 2 of 2

How to Edit Western National Insurance Online for Free

It's quite simple to prepare the ANNUITIES. Our PDF tool was intended to be assist you to fill in any form swiftly. These are the basic steps to follow:

Step 1: Press the "Get Form Now" button to get going.

Step 2: When you have accessed the ANNUITIES editing page you may discover all the actions you can conduct about your document within the upper menu.

The PDF template you desire to fill out will include the next areas:

western national insurance empty fields to fill in

Put down the information in the THE ORIGINAL CUSTOMER COPY OF, Original customer copy of policy, PLEASE ATTACH ANNUITY CONTRACT, BENEFICIARY DESIGNATION FOR NEW, IWe revoke existing designations, The New Owners Beneficiary Primary, Address City State and Zip Code, Address City State and Zip Code, Unless otherwise directed proceeds, and PRESENT OWNERS TAX ID Social field.

Completing western national insurance part 2

You need to give specific information inside the box NOTE FOR ANNUITIES ISSUED AFTER, Date Signature Present Owner, Date Signature New Owner Signature, Signature of Irrevocable, NOTE SIGNATURES MUST BE NOTARIZED, Notary Public Witness Signature, For Home Office Use Only, but without prejudice to The, Date of Acknowledgment Authorized, WNL, and Page of.

part 3 to finishing western national insurance

The Western National Life Insurance, POLICY NO OWNERS DAYTIME PHONE NO, BENEFICIARY CHANGE Beneficiary, IWe revoke existing designations, If the Beneficiary is being, The Annuitants Beneficiary Primary, Please Print Name Relationship and, Contingent Beneficiary, Address City State and Zip Code of, Please Print Name Relationship and, Address City State and Zip Code of, The Joint Owners Beneficiary, Please Print Name Relationship and, Contingent Beneficiary, and Address City State and Zip Code of segment should be applied to record the rights or responsibilities of both parties.

part 4 to filling out western national insurance

Finalize by looking at the next sections and completing them as required: The Owners Beneficiary Primary, Please Print Name Relationship and, Contingent Beneficiary, Address City State and Zip Code of, Please Print Name Relationship and, Address City State and Zip Code of, Unless otherwise directed proceeds, Previous, Address, Current Address, Annuitant Owner, From To, ADDRESS CHANGE, NAME CHANGE, and ATTACH.

part 5 to completing western national insurance

Step 3: Press the Done button to confirm that your finished document is available to be transferred to every device you select or sent to an email you specify.

Step 4: It's going to be safer to create duplicates of the file. You can rest easy that we will not display or see your details.

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