Fillable Change Of Beneficiary Form - Colonial Life (Page 2 of 2) in pdf

Changing your beneficiary is a very serious matter. To ensure your beneficiaries receive their proceeds in the

manner you desire, without any delays or disputes, it is extremely important that the form is completed correctly.

Before completing this form, we suggest you visit our web site at for additional information on

changing beneficiaries.

Once Colonial Life receives and approves this form, all other beneficiary designations are null and void.

This means if you want any of the beneficiaries previously named to continue as a beneficiary, you must include

their names on the new Change of Beneficiary Form.

If you want to have the proceeds distributed through a Trust, please contact us for additional instructions on naming

a Trust(ee) as beneficiary.

Instructions



The policyowner must complete this form in its entirety.



Print all information on the form in ink to ensure it is legible. It is extremely important we record

your beneficiary designation(s) correctly.



You must designate a primary beneficiary(s).



You may also choose to designate a contingent beneficiary(s). A contingent beneficiary is the

person or persons to receive benefits if no one listed as primary beneficiary is living at the time of

the insured’s death.



You can designate one or more primary or contingent beneficiaries. Contact us if you need more

space than provided on this form.



You must give the full name of each beneficiary and their relationship to the insured (person whose

life is covered by the policy). For example, John Jacob Doe, Spouse.



Life insurance proceeds cannot be paid to a minor beneficiary or to the natural parents of a minor

for the child’s benefit. Unless there is a court appointed legal custodian or legal guardian

(conservator) for the child’s estate named by the probate court, Colonial Life will be forced to hold

the proceeds (with interest earned on the funds) until the minor reaches the age of majority for the

state in which the child resides.



If this policy has a Cash Draft (located on the Policy Schedule page of the policy), and you return

the policy with this Change of Beneficiary Form, we will reissue the cash draft to the new

beneficiary. Note: Cash Drafts cannot be reissued to funeral homes, minors, trusts, estates or

multiple beneficiaries.



The policyowner must sign the form in ink and print their name and address.



A witness must sign the form in ink and print their name and address. The witness must be

someone other than the insured, the designated beneficiaries listed on the form, or the policyowner.



Mail or fax this form to:

Colonial Life

Fax: 1.877.828.9430

PO Box 100130

Columbia, SC 29202-1365



You will receive a letter of confirmation when the change has been completed. If there is a

provision in this policy which requires that a beneficiary change be endorsed upon the policy, it is

now waived and the desired beneficiary change will be effective, once received and approved by

Colonial Life, as of the date it was signed. We will confirm the change by US Mail.

10/10

17075-16

Change Of Beneficiary Form - Colonial Life Page 2

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