Personal Accident Insurance Beneficiary Form 2026

1. Click ‘Get Form’ to open the Personal Accident Insurance Beneficiary Form in our editor.
2. Begin by filling out the Member Information section. Clearly type or print your last name, first name, middle initial, address, member ID or social security number, city, state, and zip code.
3. In the Beneficiary Information section, designate your primary beneficiaries. Provide their full names and addresses, specify the percentage of proceeds each will receive, and include their relationship to you along with their date of birth.
4. If applicable, list contingent beneficiaries in the same manner as primary beneficiaries. Ensure that the total percentage equals 100%.
5. Review the Authorization and Acknowledgment section. Sign and date where indicated. If you have named an irrevocable beneficiary previously, ensure they also sign.

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