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How to use or fill out Select material to view
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Click ‘Get Form’ to open it in the editor.
Begin with Section 1: Employee Information. Fill in your name, policy number(s), employer name, social security number, and division number(s). Check the coverages that apply to your beneficiary designation.
Move to Section 2: Primary Beneficiary(ies). Enter the details for up to three primary beneficiaries, including their names, relationships, addresses, dates of birth, telephone numbers, social security numbers, email addresses, and the percentage of benefits each will receive. Ensure the total equals 100%.
Proceed to Section 3: Contingent Beneficiary(ies). Repeat the process for contingent beneficiaries in case all primary beneficiaries are disqualified or deceased.
Finally, complete Section 4 by signing and dating the form to confirm that all information is accurate.
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