Form 00-Ps-343-F - Request For Change Of Beneficiary / Name Change Form

REQUEST FOR CHANGE OF BENEFICIARY / NAME CHANGE FORM

Directions:

1. When completing the form, please avoid the use of the word "or" as it places the insurance company in

the position of having to choose.

2. We recommend using percentages when naming more than one Primary or Contingent beneficiary.

Please note that the Contingent beneficiary would receive the entire benefit if the Primary beneficiary is

already deceased.

3. Please make sure that the person witnessing your signature is not a beneficiary of the policy, and that

he/she is present when you sign the form.

4. After completing the form, please return it to the address on the form. Once we receive your form, it will

be validated and a copy will be returned to you for your records.

Questions? Call 1-800-922-1245 Weekdays, 8am – 6pm Eastern Time

American Insurance Administrators, P. O. Box 1149, Columbus, OH 43216-1149

Twitter: @AlumniInsurance

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Parent category: Legal