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The document is a Beneficiary Designation/Change Form from the Actra Fraternal Benefit Society (AFBS), intended for planholders to designate or change their beneficiaries for various insurance and benefit plans. It includes sections for personal information, beneficiary details, and declarations regarding the designation of primary and contingent beneficiaries, as well as special instructions. The form emphasizes the importance of completing it accurately and retaining a copy for personal records.

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