Fillable Beneficiary Change E-Form (Page 2 of 3) in pdf

SAMPLE BENEFICIARY DESIGNATIONS

Single Person: Joe Travis, husband.

Multiple People: Joe Travis, husband, 75% and Lilly Smith, daughter 25%.

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In this example, if Joe or Lilly were to pass away before the insured their portion of the benefit would automatically pass to

the other named beneficiary.

Multiple People Along Family Lines: Jason Jones (Per Stirpes), Son, 50% and Jillian Smith (Per Stirpes), Daughter 50%

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“Per Stirpes” means that if Jason or Jillian were to pass away before the insured their portion of the benefit would

automatically pass to their next of kin (e.g. spouse, children, grandchildren, etc.) rather than to the other surviving

beneficiary, unless the surviving beneficiaries are themselves the next of kin.

Multiple People by Heirs: Chris Jackson (or his Heirs), Son, 50% and Katy Hopewell (or her Heirs), Daughter 50%

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This designation means that if Chris or Katy were to pass away before the insured their portion of the benefit would

automatically pass to the person(s) named as their heir in their own will/estate rather than to the other surviving

beneficiary, unless the surviving beneficiaries are themselves the heirs. If the heirs are unclear their portion of the benefit

would pass to the beneficiary’s estate, rather than the other surviving beneficiaries.

Minor Beneficiary: Joseph Gregory, a minor, under care of Lucy or Robert Brown, aunt and uncle, until the age of majority.

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If a minor is listed as a beneficiary each state has their own rules that determine what steps will need to be taken to claim

the funds. The best way for a minor beneficiary to be listed is with a person to act on the minor’s behalf until they reach the

age of majority. We would issue a check while the beneficiary was a minor in good faith to Lucy Brown (or Robert Brown)

for Benefit of Joseph Gregory, a minor. The other way is to establish a trust (see below)

Trust: Linda Johnson Revocable Trust dated 1/13/2004, as amended 1/18/2008.

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The check will always be paid to the Trust, not a Trustee. At the time of a claim a copy of the Trust will be requested listing

the Trustee/Successor Trustee(s) who can sign the paperwork. The Trustee will divide the funds, not us. A Trust usually has

its own Trust Tax Id Number (TIN) in place of a social security number.

Estate: The Trent James Estate.

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At the time of a claim the Certified Letters of Probate will be requested which will list the Court appointed

Executor/Executrix, Administrator, or Personal Representative who can sign. An Estate usually has an Estate Identification

Number (EIN) in place of a social security number.

Partnership: The Llewelyn Limited Partnership.

Business: Chow Hounds Dogfood Incorporated.

Non-Profit Organization or Church: Muscular Dystrophy Association and the First Baptist Church of Lewisville.



NO 1099’s are ever issued to a non-profit or religious establishment.

Attorney’s Office: Scott, Bane, Smith, & Jenkins LLP.

Collateral Assignment: Please complete a Collateral Assignment Request Form



If a policy has a Collateral Assignment we will pay the amount listed in the Assignment to the Collateral Assignee with any

remainder to the beneficiary. Assignments are the only forms where dollar amounts that can be accepted. Both would sign

a Claim Form. If the Collateral Assignee has no interest in the funds we must receive a release from them as either a

statement to that effect on their Company Letterhead, or, on most contracts, by the completion of the Release of

Assignment located at the end of the contract. Collateral Assignments are usually Irrevocable, meaning the policyowner

can’t make any changes or surrender or borrow on a policy without the say so of the Collateral Assignee. If there is not

enough money to cover an assignment the entirety is paid to the Assignee.

Funeral Assignment: You may assign all or part of the proceeds to a funeral home. They can either list a specific Funeral Home,

such as the Ruffin and Jarrett Funeral Home, or as Mortuary performing Services. Once a funeral home is listed however if the

family uses Smith Funeral Home instead of Ruffin & Jarrett, we would have to have Ruffin & Jarrett disclaim the proceeds by

sending us a statement on their company letterhead to that effect. A Funeral Home can NOT be a listed beneficiary in the State

of New Jersey.

Beneficiary Change E-Form Page 2

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