Fillable Form Lp-159 - Beneficiary Change Form (Page 3 of 3) in pdf

To process your request without delay, please make sure the following have been completed:



Did the Policy Owner(s) sign and date the form?



Did you provide the SSN or Tax ID #, Telephone # and Date of Birth for all beneﬁ ciaries?



Do the percentage totals equal 100%?



Did you include the spousal signature if applicable?



Did you include an additional signature if applicable?



If you designated more than 5 Primary or Contingent Beneﬁ ciaries, did you attach an additional page signed

and dated?



Did you enclose the title and signature page of trust if listed as a beneﬁ ciary?

BENEFICIARY DESIGNATION INFORMATION

The beneﬁ ciary designation form is an IMPORTANT DOCUMENT concerning your life insurance coverage, please read the following

carefully. If multiple Primary Beneﬁ ciaries or Contingent Beneﬁ ciaries are named and no percentage distribution is noted, then any

proceeds payable to such beneﬁ ciaries will be split equally. Unless otherwise speciﬁ ed, if there is more than one Primary Beneﬁ ciary,

and one predeceases the insured, beneﬁ ts will be paid to the surviving Primary Beneﬁ ciaries according to their respective interests. If no

Primary Beneﬁ ciaries survive the insured, beneﬁ ts will be paid to the designated Contingent Beneﬁ ciaries. In the event that no Primary or

Contingent Beneﬁ ciary survives the insured, beneﬁ ts will be paid to any designated Tertiary Beneﬁ ciary, or if none, as speciﬁ ed according

to the terms of the policy. Beneﬁ ciary designation changes may have legal or tax consequences, please consult your legal or tax advisor

to discuss your individual needs. Once received, the beneﬁ ciary designation will replace all prior designations for the indicated policy.

Examples of Frequently Used Beneﬁ ciary Designations

Proposed Beneﬁ ciary

Suggested Wording

One beneﬁ ciary

Jane Jones Doe, wife.

All children (unnamed)

To all my lawful children, in equal shares with rights of survivorship. (unless speciﬁ ed

proceeds will be paid to all surviving lawful children).

Minor children

John Smith, custodian for Mary Doe, a minor, under the Uniform Transfers to Minors

Act (UTMA). [Beneﬁ ts cannot be paid to minor children unless to a custodian under

UTMA or a court appointed ﬁ nancial guardian or guardian of the minor’s estate].

An existing trust

The John Doe Irrevocable Trust, dated 1/1/2001, Eric Smith trustee.

A trust under a last will and testament

Trustee under my last will and testament as shall be admitted to probate. [Should only

be used if an appropriate trust has been set forth within the insured’s will].

Estate

To my Estate.

Non-proﬁ t organization

Name and address of the beneﬁ ciary organization.

Children, per stirpes

To all my lawful children, per stirpes. (Surviving grandchildren of a pre-deceased

child will equally share that child’s portion; this option could also be used for named

children).

Speciﬁ ed secondary beneﬁ ciary

Jane Jones Doe, wife, if predeceased then Mary Ann Doe, sister. (Used to designate

a Secondary Beneﬁ ciary rather than distribute a predeceasing Primary Beneﬁ ciary’s

share to the remaining Primary Beneﬁ ciaries, please provide Date of Birth and SSN or

Tax ID # for the Secondary Beneﬁ ciary in the Comments section).

Irrevocable beneﬁ ciary

Jane Jones Doe, wife, irrevocable beneﬁ ciary.

Contact Information

Legal & General America

1-800-638-8428 (telephone)

Banner Life Insurance Company

1-301-294-6960 (fax)

3275 Bennett Creek Avenue

Frederick, Maryland 21704

Faxed, email or mailed copies will be accepted.

LP-159 (7-12)

Form Lp-159 - Beneficiary Change Form Page 3

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