Fillable Beneciary Designation Form (Hope College)

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Beneciary Designation Form (Hope College)

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Page 1 of 2
GLC-02170 BNFCRYINF 5/17
The Lincoln National Life Insurance Company
PO Box 2649, Omaha, NE 68103-2649
toll free (800) 423-2765 Fax (800) 462-4660
www.LincolnFinancial.com
Beneciary Designation Form
Policyholder/Employer Policy Number(s)
Employee Name Employee Social Security or Certicate Number
Employee Address (Street, City, State) Employee Telephone Number
WHO ARE YOUR BENEFICIARIES?
It is very important to clearly indicate your primary beneciary(ies) and contingent beneciary(ies). Proceeds are paid to contingent
beneciary(ies) only if there is no surviving primary beneciary(ies). If multiple primary beneciaries or contingent beneciaries are named
and no percentage distribution is noted, then any proceeds payable to such beneciaries will be split equally. If more space is needed to
list your beneciaries please attach a sheet to this form. The beneciary(ies) named on this form will be valid for all basic, optional,
and/or voluntary group term life and AD&D, Accident and Critical Illness coverages unless otherwise indicated by you. The
beneciary designation may not go into effect until this form is signed and dated by you. Page 2 of this form includes examples
of how to complete this form.
PRIMARY BENEFICIARY(IES)
Primary Beneciary’s Name and Address
Social Security
Number
Relationship
to You
Date of
Birth
Percentage:
Must equal 100%
Name:
Address:
Name:
Address:
Name:
Address:
CONTINGENT BENEFICIARY(IES): Contingent beneciaries will only receive benet if there are no surviving primary beneciaries.
Contingent Beneciary’s Name and Address
Social Security
Number
Relationship
to You
Date of
Birth
Percentage:
Must equal 100%
Name:
Address:
Name:
Address:
Name:
Address:
Community Property State Consent for residents of Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas,
Washington, or Wisconsin. If you are married, live in a community property state, and name someone other than your spouse as
beneciary, you may have your spouse sign below to waive his or her rights to any community property interest in the benet.
As the Insured’s spouse, I do hereby consent to the beneciary designation(s) indicated on this form and waive any rights that
I may have to the proceeds of such insurance under applicable community property laws.
_________________________________________________________________ ______________________________
Signature of Spouse Date
__________________________________________________________________ ______________________________
Signature of Employee Date
Lincoln Financial Group is the marketing name for Lincoln National Corporation and its afliates.
Page 2 of 2
GLC-02170 BNFCRYINF 5/17
COMPLETING YOUR BENEFICIARY DESIGNATION FORM
1. At the top of the form, ll in the information regarding your employer and yourself.
2. Next complete the information regarding who will be your primary and contingent beneciaries. A primary beneciary will be the
person/people that you want to receive the life insurance benet. The contingent beneciary or beneciaries will only receive
the life insurance benet if the primary beneciary(ies) is no longer living. Indicate the percentage of the benet amount that
the beneciary will receive. Do not use dollar amounts. Percentages must add up to 100%.
3. If you live in a community property state, are married and naming someone other than your spouse as the primary beneciary,
you should have your spouse sign this form to avoid any delays at claim time.
4. Sign and date the form.
Below is an example of how to complete the beneciary designations:
PRIMARY BENEFICIARY(IES)
Primary Beneciary’s Name and Address
Social Security
Number
Relationship
to
You
Date of
Birth
Percentage:
Must equal 100%
Name:
Jill Doe
Address: 123 Main St, Anytown, NE 00000
XXX-XX-XXXX Wife XX/XX/XX 100%
Name:
Address:
Name:
Address:
CONTINGENT BENEFICIARY(IES): Contingent beneciaries will only receive benet if there are no surviving primary beneciaries.
Contingent Beneciary’s Name and Address
Social Security
Number
Relationship
to You
Date of
Birth
Percentage:
Must equal 100%
Name: John Doe Sr
Address: 456 Main Ln, Anytown, NE 00000
XXX-XX-XXXX Father XX/XX/XX 50%
Name: Mary Doe
Address: 789 Main Rd, Anytown, NE 00000
XXX-XX-XXXX Sister XX/XX/XX 25%
Name: Jack Doe Irrevocable Trust, Jill Doe TTEE UTA 1/04
Address: 123 Main St, Anytown, NE 00000
XXX-XX-XXXX Trust 25%
FREQUENTLY ASKED QUESTIONS
Should I name a minor child as a beneciary?
You may name a minor child as a beneciary, however please be aware that we cannot make payment of a claim directly to a
minor. If a claim is incurred we would need to make payment via UTMA or to the guardian of the minor’s nancial estate. Or, if
guardianship is not obtained and if UTMA does not apply, the benet will be placed On Hold - Age of Majority and payable once
the minor reaches the age of majority.
How would I name a Charitable Organization as a beneciary?
A charitable organization that is not your employer may be named as a beneciary. You will need to indicate the name of the charitable
organization, a contact for the organization, their tax identication number, and the percentage of the benet that would be
payable to them.
How do I name my Estate as the beneciary?
You may name your estate as a beneciary. To name your estate as the beneciary indicate “My Estate” as the beneciary. If you
know who will be the executor or administrator of your estate you should also include that person’s name. For example: My
Estate, John Doe Executor.
How do I name a Trust as the beneciary?
You may designate a trust as a beneciary. To name a trust as a beneciary, indicate Trustee (show Name and address) under Trust
Agreement Dated (show date). If the trust has a tax identication number that will need to be supplied in place of the social security
number. For example: Jack Doe Irrevocable Trust, Jill Doe TTEE UTA 1/1/04.
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Completed 21 August 2020

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