Form Jhga8 - John Hancock Life Insurance Company Beneficiary Form printable pdf download

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John Hancock Life Insurance Company

Fixed Products Operations, S-8

380 Stuart Street

Boston, MA 02117

Toll Free # : 1-800-624-5155

BENEFICIARY FORM

- See Instructions on Page 2-

Contract Number : _________________GAC

Issued To: ________________________________________________

SECTION I – ELECTION OF / CHANGE OF BENEFICIARY

I, _______________________________________________, hereby revoke all previous beneficiary designations

under Certificate # _________________ and the above numbered contract and designate the following

beneficiary (or beneficiaries) in lieu of those revoked above, effective on and after _____/_____/_____ to receive

any death benefit payable under the terms of the said contract still reserving to myself the privilege of other and

further changes, in accordance with the provisions of said contract.

Primary

Beneficiary

_________________________________________________________________________________________________________________

Last

First

Middle Initial

Relationship

Date of Birth

Social Security Number

Contingent

Beneficiary

_________________________________________________________________________________________________________________

Last

First

Middle Initial

Relationship

Date of Birth

Social Security Number

_________________________________________________________________________________________________________________

Last

First

Middle Initial

Relationship

Date of Birth

Social Security Number

_________________________________________________________________________________________________________________

Last

First

Middle Initial

Relationship

Date of Birth

Social Security Number

* If you are married and the Primary Beneficiary is other than your spouse, complete the Spousal Consent on the

second page of this form.

If more than one beneficiary is designated, settlement will be made in equal shares to such of the designated beneficiaries (or

beneficiary) as survived me, unless otherwise provided herein. If no designated beneficiary survives me, settlement will be made as

provided in the contract.

This election / change of beneficiary shall take effect upon receipt of this instrument at the Home Office of the John Hancock and

when so received, the change shall be operative as of the date specified above whether or not I am alive at the time of such receipt,

but without prejudice to the John Hancock on account of any payment made by it before such receipt. The John Hancock shall not

be bound by any trust deed, and shall not be liable for the application of monies by a trustee beneficiary.

SECTION II – CORRECTION OF NAME

It is hereby requested that the name of the {

} BENEFICIARY

{

} CONTINGENT ANNUITANT (check one)

under Certificate # ___________________ and the above numbered contract appearing on the Company records

as _________________________________________ be changed to _________________________________

_______________________ because of _________________________________________________________

SECTION III – PARTICIPANT’S AUTHORIZATION

I hereby authorize the changes in Section I {

} and / or Section II {

}

Dated at ___________________________________________ on ______________________________, 20___

X___________________________________________

Signature of Participant

ACKNOWLEDGEMENT BY COMPANY

The John Hancock Life Insurance Company acknowledges receipt on this date of the foregoing instrument at its Home Office

and assents to the request therein contained.

Dated at Boston, MA on __________________________ by ________________________________________________

John Hancock Financial Services

Form Jhga8 - John Hancock Life Insurance Company Beneficiary Form

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