Form Approved Designation of Beneficiary OMB No. 3206-0136 Federal Employees Federal Employees' Group Life Insurance (FEGLI) Program Important:
Patient's Name: Medicare # (HICN): A DVANCE B ENEFICIARY N OTICE (ABN) NOTE: You need to make a choice about receiving these health care items or services.
18000104684B (07/11) eF BENEFICIARY CHANGE FORM •*Name*new*Owner's*beneficiary*and/or*new*Owner's*contingent*beneficiary. •*Must*accompany*Form*A*when*naming*new*Owner/Joint*Owner* (NQ).
What is a beneficiary & why is it important that I make a designation? A beneficiary is the person (or persons) you elect to receive a benefit in the event of your death.
21131 (9/09) Page 1 of 5 RETURN FORM TO: CHANGE OF BENEFICIARY Instructions and Examples of Beneficiary Designations Change Of Beneficiary Request Form Provisions Relating To Beneficiary Designation, and Notice Regarding Testamentary Trust Page 2 Page 3 & 4 Page 5 This section for Agent's ...
Any benefits payable by the Wisconsin Retirement System and Life Insurance program at my death shall be paid in EQUAL SHARES, unless otherwise specified, to the following primary beneficiary(ies) who survive me.
Page 1 of 3 DRS MS 100 (R 8/10) Member/Retiree Information Name (Last, First, Middle) Social Security Number Mailing Address City State ZIP Daytime Phone Number ( ) E-mail Address MeMbeR/RetIRee benefIcIaRy DesIgnatIon PO Box 48380 Olympia, WA 98504-8380 w www.drs.wa.gov Toll Free: 1-800-547 ...
Page 1 of 5. Questions? Go to personal.fidelity.com/beneficiary or call 1-800-544-6666. Beneficiaries – Transfer on Death. Use this form to establish or update the beneficiaries on a Transfer on Death (TOD) registration on your non-retirement Fidelity Account
designation of beneficiary government life insurance important - see instructions on reverse va form dec 2005 29-336 supersedes va form 29-336, feb 2003, which will not be used.
DESIGNATION OF BENEFICIARY continued on next page F1387 (06/06) FOR: •Group Supplemental Retirement Annuities Supplemental Retirement Annuities • Retirement Choice Plus Group Retirement Annuities Retirement Annuities • Retirement Choice • TIAA Stable Return Annuity After-Tax ...