review their beneficiary designations - AccessAllstate
review their beneficiary designations - AccessAllstate
review their beneficiary designations - AccessAllstate
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Lincoln Benefit Life Company<br />
THIS FORM NOT TO BE USED WITH SECTION 401 OR 403(b) CONTRACTS P.O. Box 80469, Lincoln, NE 68501-0469<br />
TEL: 1-800-525-9287<br />
Use ball point pen when completing form<br />
FAX: (Annuities) 1-877-525-2689 (Life) 1-866-525-5433<br />
STEP 1 - CONTRACT/POLICY INFORMATION (ALL FIELDS MUST BE COMPLETED). Only one policy number<br />
and Insured/Annuitant per change form. Submit a separate change of <strong>beneficiary</strong> form for each policy.<br />
Owner’s Name Owner’s SSN/TIN Contract/Policy #<br />
Joint Owner’s Name (if applicable)<br />
Insured or Annuitant’s Name<br />
Name and Date of Trust<br />
Name of Current Trustee<br />
Trust Tax ID Number<br />
Joint Owner’s SSN/TIN<br />
Insured or Annuitant’s SSN/TIN<br />
STEP 2 - PRIMARY BENEFICIARY (IES) – If more than 2 Primary Beneficiaries, please use a separate sheet of paper and<br />
attach to this form. Percentages must add up to 100%.<br />
If the Contract Owner is the TRUST then the Beneficiary should also be the TRUST.<br />
A. Individual, Corporation or Estate<br />
Name of Primary Beneficiary #1<br />
Name of Primary Beneficiary #2<br />
NOTE: Please use WHOLE Percentages ONLY<br />
NOTE: Please use WHOLE Percentages ONLY<br />
Street Address<br />
Street Address<br />
City/State/Zip<br />
City/State/Zip<br />
SSN/TIN<br />
Date of Birth (MM/DD/YYYY) SSN/TIN<br />
Date of Birth (MM/DD/YYYY)<br />
Relationship<br />
Relationship<br />
B. Trust as Primary Beneficiary (NOT Under Last Will)<br />
Street Address City State Zip<br />
C. Trust as Primary Beneficiary (Trust Within Last Will)<br />
To the trustee of the trust created pursuant to the Last Will and Testament of ____________________________ as admitted<br />
Name<br />
to probate provided the trustee submits a written claim within six months of the death of the person that triggered payment<br />
under the policy. If no such claim is made by the trustee, the proceeds shall be paid to _______________________________.<br />
Name<br />
STEP 3 - CONTINGENT BENEFICIARY(IES) – If more than 2 Contingent Beneficiaries, please use a separate sheet<br />
of paper and attach to this form. Percentages must add up to 100%.<br />
Name of Contingent Beneficiary #1<br />
Name of Contingent Beneficiary #2<br />
NOTE: Please use WHOLE Percentages ONLY<br />
NOTE: Please use WHOLE Percentages ONLY<br />
Street Address<br />
Street Address<br />
City/State/Zip<br />
City/State/Zip<br />
SSN/TIN<br />
Date of Birth (MM/DD/YYYY) SSN/TIN<br />
Date of Birth (MM/DD/YYYY)<br />
Relationship<br />
Relationship<br />
FIC77LBL-2 Page 4 of 5 (08/09)<br />
Review your beneficiaries.<br />
Name and relationship<br />
of <strong>beneficiary</strong><br />
Are they currently a<br />
<strong>beneficiary</strong>? How much<br />
will they receive?<br />
What do you hope<br />
this person will do<br />
with the proceeds? 3<br />
Is action needed?<br />
Example:<br />
Connie Johnson<br />
Wife of 20 years<br />
Yes<br />
$400,000<br />
Pay off all debts and<br />
put the kids through<br />
college, without having<br />
to work full time.<br />
Yes. Based on our<br />
current expenses, I<br />
need to increase her<br />
share of the proceeds<br />
to $550,000.<br />
If you answered anything other than 'No' in this column, then action is needed.<br />
Make an appointment with your financial professional today to<br />
discuss how to help protect your loved ones in the future.<br />
REQUEST FOR<br />
CHANGE OF BENEFICIARY (PAYEE)<br />
❑ Equally OR ❑ Percentage %<br />
❑ Equally OR ❑ Percentage %<br />
Use our Change of Beneficiary form (FIC77LBL)<br />
to update the beneficiaries on your LBL policies.<br />
❑ Equally OR ❑ Percentage %<br />
❑ Equally OR ❑ Percentage %<br />
3 Beneficiaries may use proceeds for any purpose and are under no contractual obligation to carry out the owner's desires.<br />
LBL8060