Form Cs06893 - Life Beneficiary And Name Change Form
Download a blank fillable Form Cs06893 - Life Beneficiary And Name 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 Form Cs06893 - Life Beneficiary And Name 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
3Customer Service Mailing Address
P.O. Box 515
Concord NH 03302-0515
PO Box 21008
Greensboro NC 27420-1008
LIFE BENEFICIARY AND NAME CHANGE FORM
Benefi ciary Change
Name Change
GENERAL INFORMATION
This section must be completed.
Policy/Certifi cate No.: ________________________________________ Issued by (the Company): __________________________
Insured’s Name: _____________________________________________________________________________________________
Current Owner’s Name: _______________________________________________________________________________________
Current Owner’s Social Security Number/Tax ID # __________________________________________________________________
Current Owner’s Address: _____________________________________________________________________________________
City, State, Zip: ______________________________________________________________________________________________
Daytime Telephone No.: ____________________________Email Address: ______________________________________________
Check here if new address
BENEFICIARY DESIGNATION
If this form does not accommodate your needs, please contact Customer Service.
Designations given in dollar amounts will not be accepted. However, designations given in percentages or fractions will be accepted.
Unless otherwise stated below, if joint benefi ciaries are named in any of the three classes (Primary, Contingent, or Second Contingent),
the proceeds are to be paid equally to the survivor or survivors, if any, in the class. If unnamed children of the Insured are designated
below as benefi ciaries, the proceeds are to be paid to the Insured’s lawful children unless otherwise specifi ed.
If there is a provision in said policy requiring that it accompany any request for change of benefi ciary or that such change shall not
take effect until endorsed by the Company on the policy, such provision is hereby modifi ed, and the benefi ciary may be changed
pursuant to this written request, which change will be effected by recordation by the Company at its Home Offi ce or Administrative
Offi ce without action taken by the Company before such recordation.
If you are adding benefi ciaries but not changing existing benefi ciaries, you must restate all existing benefi ciaries below as well.
Change benefi ciaries on: (select one)
Base policy
Children term rider(s)
Primary Insured Rider
First to die rider
Other Insured rider--on the life of the __________________
Last to die rider
If you do not select one of the options, we will automatically change the benefi ciaries on the base policy and the primary insured
rider (if applicable).
For Trust Designation see page 2.
Primary Name ___________________________________________________________________________________________
Social Security Number/Tax ID # _______________________________________________________________________________
Relationship to the Insured _______________________________________________ Date of Birth _________________________
Address ___________________________________________________________________________________________________
Primary
Contingent
Name _____________________________________________________________________________________________________
Social Security Number/Tax ID # _______________________________________________________________________________
Relationship to the Insured _______________________________________________ Date of Birth _________________________
Address ___________________________________________________________________________________________________
Primary
Contingent
Second Contingent
Name _____________________________________________________________________________________________________
Social Security Number/Tax ID # _______________________________________________________________________________
Relationship to the Insured _______________________________________________ Date of Birth _________________________
Address ___________________________________________________________________________________________________
Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affi liates.
Page 1 of 3
CS06893
10/10
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal