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To designate a beneficiary or to change your existing beneficiary designation on your plan, complete all applicable sections of this form, obtain any required signatures, and return it to your Plan Sponsor at Prevea Clinic, Inc. P.O. Box 19070 2710 Executive Drive, Green Bay, WI 54303. Phone: 920-496-4712.
Change a beneficiary Generally, you can review and update your beneficiary designations by contacting the company or organization that provides your insurance or retirement plan. You can sometimes do this online. Otherwise, youll have to complete, sign, and mail a paper form.
Most beneficiary designations will require you to provide a persons full legal name and their relationship to you (spouse, child, mother, etc.). Some beneficiary designations also include information like mailing address, email, phone number, date of birth and Social Security number.
How to change the beneficiary of your life insurance policy. You can change the beneficiaries of your life insurance by contacting your insurance company. Youll need to submit a change of beneficiary form online, on paper, or over the phone.
Write only one beneficiary on each line. Make sure that you write the full names of all beneficiaries. For example, if you name you children as beneficiaries, DO NOT merely write children on one of the lines; instead write the full names of each of your children on separate lines.
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Change a beneficiary Generally, you can review and update your beneficiary designations by contacting the company or organization that provides your insurance or retirement plan. You can sometimes do this online. Otherwise, youll have to complete, sign, and mail a paper form.
The beneficiary can be either revocable or irrevocable. A revocable beneficiary can be changed at any time. Once named, an irrevocable beneficiary cannot be changed without his or her consent.
Your original designation remains in force whether it still reflects your wishes or not, until you submit another form to cancel prior designations or to designate a new beneficiary. A designation of beneficiary form outlines your desire to have the funds due upon your death paid out in a particular way.

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