Life Insurance Beneficiary Designation Form - Anthem: Fill out & sign online

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Click ‘Get Form’ to open the Life Insurance Beneficiary Designation Form in the editor.
Begin by entering the 'Name of Insured' and their 'Social Security No.' in the designated fields. If the policyowner differs from the insured, provide their details as well.
Fill in the 'Name of Employer/Group' and 'Policy/Certification No.' if applicable. This information helps identify your policy accurately.
Designate your Primary Beneficiaries by entering their names, addresses, dates of birth, relationships to you, social security numbers, and the percentage of proceeds they will receive. Ensure total percentages equal 100%.
If necessary, list Contingent Beneficiaries using the same format as above. These individuals will receive benefits if no Primary Beneficiaries survive.
Finally, sign and date the form at the bottom. If required, include your spouse's signature if they are not a Primary Beneficiary in a community property state.

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