Fillable Form Ben-Cskc - Beneficiary Change Form printable pdf download

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Monumental Life Insurance Company

Beneficiary

Stonebridge Life Insurance Company

Change Form

Transamerica Life Insurance Company

Western Reserve Life Assurance Company of Ohio

Fax Number 1-800-297-9120

Administrative Office located at: 4333 Edgewood Rd. NE, Cedar Rapids, IA 52499

Section A:

Instructions and Signature Requirements

BUSINESS/ENTITY-OWNED POLICIES: If a corporation, partnership or institutional body is the policy owner, an

Entity Certification Form or a copy of a Corporate Resolution must be on file with the Company or submitted with this Beneficiary

Change Form.

TRUST-OWNED POLICIES: The complete name and date of the trust should be listed in Section 1. Trustee(s) must sign in

Section 4, and include their title as trustee(s). A Trustee Certification Form and a copy of a Corporate Resolution, if applicable, for

a corporate trustee, must be on file or included with this Beneficiary Change Form.

GUARDIAN OR CONSERVATOR: A court-appointed guardian of the estate or conservator may sign on behalf of the policy

owner in accordance with state laws or pursuant to a specific court order. A copy of the letters of guardianship/conservatorship

must be on file with the Company or submitted with this Beneficiary Change Form and any applicable court order.

POWER OF ATTORNEY: An agent acting under a Power of Attorney on behalf of the policy owner must sign in his/her capacity

in Section 4. A complete copy of the Power of Attorney document must be on file with the Company or submitted with this

Beneficiary Change Form.

NAMING A FUNERAL HOME AS A BENEFICIARY: When a funeral home is named as the beneficiary, there is a possibility

that the proceeds from the policy may exceed the cost of the funeral. The funeral home may not be obligated to refund the

remainder of the proceeds. You may have the option to collaterally assign the policy instead. You may wish to speak with your

agent, attorney or financial planner for additional information on establishing payment to a funeral home.

COLLATERAL ASSIGNMENTS: Payment of proceeds to any beneficiary is subject to the interest of any collateral assignee on

the policy.

IRREVOCABLE BENEFICIARIES: To name your beneficiary as irrevocable, please write “Irrevocable” next to the name of the

beneficiary on the form. If a beneficiary is named as irrevocable, the beneficiary designation cannot be changed without the

consent of the irrevocable beneficiary. Any irrevocable beneficiary must sign this and any subsequent beneficiary change requests.

The irrevocable beneficiary may be required to sign other requests for changes to, or disbursements from, the policy.

TRUST/MINOR BENEFICIARIES: If a trust is named beneficiary, the Company shall not be responsible for the disposition by

the trustee of any proceeds paid to the trustee. Any payment to a minor beneficiary shall be made to the legally appointed guardian

of the estate or conservator of the minor, unless otherwise permitted by law.

PER STIRPES DESIGNATIONS: A per stirpes designation will direct death benefits to lineal descendants of the beneficiary if

the beneficiary is not living at the time of claim. You may wish to seek legal counsel regarding use of per stirpes designations.

PERCENTAGES: Please do not specify dollar amounts. Use percentages totaling 100% for primary and contingent designations.

Primary beneficiaries should total 100% and contingent beneficiaries should independently total 100%.

Section B:

Sample Beneficiary Designations

TRUST: John Doe Revocable Trust, dated 01/01/1999

IRREVOCABLE BENEFICIARY: Jane Doe, Irrevocable

CORPORATE CREDITOR: ABC Co., Inc., Creditor, a California Corporation, its successors and assigns, as its interest may

appear; remainder, if any, to Jane Doe, Spouse

TRUSTEE UNDER LAST WILL AND TESTAMENT: Testamentary trust under the Last Will and Testament of NAME, if

created under the will; otherwise, _________________(estate, individual, etc)”.

PER STIRPES DESIGNATIONS: John Doe 50%, per stirpes and Jane Doe 50%, per stirpes

BEN‐CSKC 02/14

Form Ben-Cskc - Beneficiary Change Form

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