Western National Insurance PDF Details

Western National Insurance is one of the most reputable and reliable insurance companies in the country. They offer a variety of insurance products, including car, home, and life insurance. Western National also offers excellent customer service, and their representatives are always available to help you with your policy needs.

This page includes details about western national insurance. This article will provide specifics of the form's length, completion duration, and the parts you will be required to fill.

QuestionAnswer
Form NameWestern National Insurance
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesWNL, DESIGNATION, western national insurance, western national life insurance company amarillo texas

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)

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