Vgli Beneficiary Designation/change Form Page 2
Download a blank fillable Vgli Beneficiary Designation/change Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Vgli Beneficiary Designation/change Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4Control #:
(See Billing Statement)
2
BENEFICIARY DESIGNATION
I hereby revoke any previous designation of primary beneficiary(ies) and secondary beneficiary(ies), if any, and in the event of my death, designate
the following:
Payment to Beneficiaries
If you want the beneficiary(ies) to receive 36 equal monthly payments rather than a lump sum*, you should fill in the corresponding box under
Payment Option. If you choose 36 payments, the beneficiary cannot choose to receive a lump sum payment at the time of your death. If you want
the beneficiary to have a choice at the time of payment, leave the fields blank.
A. Primary Beneficiaries
are the person(s) or entity you choose to receive your life insurance proceeds. Payment will be made in equal shares
unless otherwise specified. In the event that a designated primary beneficiary predeceases the Insured, the proceeds will be paid to the remaining
primary beneficiaries in equal shares or all to the sole remaining primary beneficiary.
The total for all primary beneficiaries must equal 100%.
1. Type
Charitable Institution
Child
Parent
Spouse
Other Family
Other
Trust
Estate
(Select One)
Male
Female
Gender:
MI:
First Name:
Last Name:
Address:
SSN:
Phone:
36 Equal Monthly Payments
Payment:
Share:
%
Lump Sum*
2. Type
Child
Parent
Spouse
Other Family
Other
Trust
Estate
Charitable Institution
(Select One)
Male
Female
Gender:
First Name:
MI:
Last Name:
Address:
Phone:
SSN:
Payment:
36 Equal Monthly Payments
Share:
%
Lump Sum*
3. Type
Child
Parent
Spouse
Other Family
Other
Trust
Estate
Charitable Institution
(Select One)
Gender:
Male
Female
First Name:
MI:
Last Name:
Address:
SSN:
Phone:
Payment:
36 Equal Monthly Payments
Share:
%
Lump Sum*
* If the insured member elects a lump sum payment, the beneficiary(ies) will be given the option of receiving
the lump sum payment through the Prudential Alliance Account
, by check, or Electronic Funds Transfer (EFT).
TOTAL:
%
®
Alliance Account is not available for payments less than $5,000, payments to individuals residing outside the
United States and its territories, and certain other payments. These will be paid by check.
Must equal 100%
The Bank of New York Mellon is the Administrator of the Prudential Alliance Account Settlement Option, a contractual obligation of The Prudential Insurance
Company of America, located at 751 Broad Street, Newark, NJ 07102-3777. Draft clearing and processing support is provided by The Bank of New York Mellon.
Alliance Account balances are not insured by the Federal Deposit Insurance Corporation (FDIC). The Bank of New York Mellon is not a Prudential
Financial company.
*06100B02*
GL.2006.100B Ed. 06/2014
Page 2 of 4
*
0
6
1
0
0
B
0
2
*
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business