Form Gr-Ad-Bene-Emp-Csea - Metlife Accidental Death (Ad) Beneficiary Designation - 2014 Page 2
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1
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3CONTINGENT BENEFICIARY -
Your second choice to receive your life insurance proceeds if ALL of your primary beneficiary(ies)
are not living at the time of your death. If any contingent beneficiaries predecease you, that person’s share will be equally divided among
any remaining contingent beneficiaries.
First Name
Middle Initial
Last Name
Share:
%
Address – Street
City
State
ZIP Code
Relationship to Employee
Social Security Number
Date of Birth
Phone Number
(
)
First Name
Middle Initial
Last Name
Share:
%
Address – Street
City
State
ZIP Code
Relationship to Employee
Social Security Number
Date of Birth
Phone Number
(
)
B. Living Trust –
Primary
Contingent
If this form is executed by the insured, it is understood and agreed that if MetLife receives satisfactory proof that the aforesaid trust
has been revoked or is not in effect at the insured’s death, the beneficiary shall be the insured’s Estate, unless otherwise indicated on
this form.
Share:
Trust Name
Trust Date
Trustee Phone Number
(
)
%
Trustee - First Name
Middle Initial
Last Name
Trustee Address – Street
City
State
ZIP Code
C. Testamentary Trust Created in the Insured's Will
–
Primary
Contingent
The trust(ee) under any last Will and Testament of mine as shall be admitted to probate.
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%
D. Insured's Estate –
Primary
Contingent
If the Insured’s Estate is selected as the Primary Beneficiary, no Contingent Beneficiary may be named.
E. Charity/Organization –
Primary
Contingent
Be sure to name the charity or organization and not the charity or organization director or an employee of that charity/organization.
Share:
Charity/Organization Name
Phone Number
%
(
)
Address – Street
City
State
ZIP Code
Metropolitan Life Insurance Company
Page 2 of 3
GR-AD-BENE-EMP-CSEA (04/14) Fs
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