Fillable Va Form 29-336 - Designation Of Beneficiary - Government Life Insurance printable pdf download

Va Form 29-336 - Designation Of Beneficiary - Government Life Insurance

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OMB Approved No. 2900-0020

IMPORTANT - SEE INSTRUCTIONS ON REVERSE

Respondent Burden: 10 minutes

DESIGNATION OF BENEFICIARY

GOVERNMENT LIFE INSURANCE

DO NOT WRITE IN SPACE BELOW - FOR VA USE ONLY

ENTERED BY VA

DATE RECORDED

SIGNATURE OF VA INSURANCE OFFICIAL

(Type or print)

1A. NAME OF INSURED AND MAILING ADDRESS FOR INSURANCE PURPOSES

(First, Middle, Last Name)

2A. INSURANCE FILE NUMBER

(Number and street or rural route)

2B. SOCIAL SECURITY NUMBER

(City or P.O., State and ZIP Code)

3. DAYTIME TELEPHONE NUMBER

(Include Area Code)

YES

1B. IS THIS A CHANGE OF ADDRESS FOR YOUR INSURANCE?

4. BENEFICIARY DESIGNATION

D. SHARE TO EACH

C. RELATION-

B. BENEFICIARY'S SOCIAL

A. SHOW FULL NAME AND ADDRESS OF EACH

E. OPTION

(If known

SECURITY NO.

(Use fractions, such

SHIP TO

BENEFICIARY ENTERED IN THE PRINCIPAL AND

See instruction No. 5 on

FOR EACH

INSURED

as 1/2, 2/3, or "all")

CONTINGENT BENEFICIARY AREAS BELOW

reverse)

PRINCIPAL

LUMP SUM

OR TO SURVIVORS

CONTINGENT

(Person(s) who get proceeds if all of the Principal

Beneficiaries die before the insured. If none, write "none")

LUMP SUM

OR TO SURVIVORS

(Include any additional information which will clarify your intent regarding the payment of your insurance. Also, list the policy

5. REMARKS

number of any policy on which the beneficiary is not to be changed)

I understand that this change cancels all prior beneficiary and option selections; and unless indicated in Item 5, Remarks, this change applies to all

Government Life Insurance policies under the above file number.

(Do NOT print) (Power of Attorney signatures are NOT acceptable)

7. DATE

6. SIGNATURE OF INSURED

Type or print)

8. NAME AND ADDRESS OF WITNESS (

If you have any questions concerning designating a beneficiary, call us toll free at 1-800-669-8477.

29-336

VA FORM

EXISTING STOCKS OF VA FORM 29-336,

SEP 2014

APR 2010, WILL BE USED.