Liberty pla 2005142 2026

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The document is a Contract Change Request form from Liberty Life Assurance Company of Boston, designed for policyholders to request changes related to their insurance contracts. It includes sections for insured and owner information, name changes, ownership transfers, withdrawal requests, loan processing, surrender options, tax withholding preferences, and necessary authorizations. The form requires signatures from relevant parties and provides guidelines on tax implications and certification of Social Security or Tax ID numbers.

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Click ‘Get Form’ to open the liberty pla 2005142 in the editor.
Begin by filling out the 'Representative Name' and 'Office Name/Number' at the top of the form. Ensure all details are accurate for proper identification.
In Section 1, provide the Insured/Annuitant Information. Fill in fields such as First Name, Last Name, Street Address, City, State, Telephone Number, Birth Date, and Social Security/Tax ID Number.
If applicable, complete Section 2 for Owner(s) Information. Repeat the same process as in Section 1 for any additional owners.
For Joint Owner Information in Section 3, enter details similar to previous sections if there is a joint owner.
Proceed to Section 4 for Change of Name Information. Indicate if it’s for Insured/Annuitant or Owner and provide legal evidence if necessary.
In Sections 5 through 10, follow prompts to fill out New Owner/Payor Change Information, Withdrawal requests, Loan processing options, Surrender rights, and Tax Withholding preferences.
Finally, review your entries in Sections 11 through 14 for Authorization and Signatures. Ensure all required signatures are included before submission.

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