Form r0782ghb 2026

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The document is a Life Insurance Beneficiary Designation form for members of the State, State Police, and Judges in Michigan. It allows members to designate primary and contingent beneficiaries for their life insurance benefits, detailing requirements for naming beneficiaries, including the need for equal shares or specific percentages. The form must be signed in front of a Notary Public and includes instructions on how to complete it, as well as guidelines for what happens if no beneficiaries are named.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information in the designated fields, including your name, member ID or SSN, mailing address, and daytime telephone number.
In Section I, list your primary beneficiaries. For each beneficiary, provide their full name, SSN, birthdate, address, relationship to you, and the percentage share of benefits they will receive. Ensure that the total percentage equals 100%.
Proceed to Section II to designate any contingent beneficiaries. Repeat the same process as in Section I for these individuals.
Finally, review Section III carefully. Do not sign until you are in front of a Notary Public. Once verified, sign and date the form.

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