Fillable Beneficiary Change Form Section A: Instructions and Si (Transamerica)

Fill Online, Printable, Fillable, Blank Beneficiary Change Form Section A: Instructions and Si (Transamerica) Form

Use Fill to complete blank online TRANSAMERICA pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Beneficiary Change Form Section A: Instructions and Si (Transamerica)

On average this form takes 21 minutes to complete

The Beneficiary Change Form Section A: Instructions and Si (Transamerica) form is 4 pages long and contains:

  • 0 signatures
  • 8 check-boxes
  • 81 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Transamerica forms online.

BROWSE TRANSAMERICA FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Transamerica Life Insurance Company
Transamerica Premier Life Insurance Company
Fax Number 1-800-235-4782
Administrative Office located at: 4333 Edgewood Rd. NE, Cedar Rapids, IA 52499
BEN-CCC 02/14
Beneficiary
Change Form
BUSINESS/ENTITY-OWNED POLICIES: If a corporation, partnership or institutional body is the policy owner, an
Entity Certification Form or a copy of a Corporate Resolution must be on file with the Company or submitted with this Beneficiary
Change Form.
TRUST-OWNED POLICIES: The complete name and date of the trust should be listed in Section 1. Trustee(s) must sign in
Section 4, and include their title as trustee(s). A Trustee Certification Form and a copy of a Corporate Resolution, if applicable, for
a corporate trustee, must be on file or included with this Beneficiary Change Form.
GUARDIAN OR CONSERVATOR: A court-appointed guardian of the estate or conservator may sign on behalf of the policy
owner in accordance with state laws or pursuant to a specific court order. A copy of the letters of guardianship/conservatorship
must be on file with the Company or submitted with this Beneficiary Change Form and any applicable court order.
POWER OF ATTORNEY: An agent acting under a Power of Attorney on behalf of the policy owner must sign in his/her capacity
in Section 4. A complete copy of the Power of Attorney document must be on file with the Company or submitted with this
Beneficiary Change Form.
NAMING A FUNERAL HOME AS A BENEFICIARY: When a funeral home is named as the beneficiary, there is a possibility
that the proceeds from the policy may exceed the cost of the funeral. The funeral home may not be obligated to refund the
remainder of the proceeds. You may have the option to collaterally assign the policy instead. You may wish to speak with your
agent, attorney or financial planner for additional information on establishing payment to a funeral home.
COLLATERAL ASSIGNMENTS: Payment of proceeds to any beneficiary is subject to the interest of any collateral assignee on
the policy.
IRREVOCABLE BENEFICIARIES: To name your beneficiary as irrevocable, please write “Irrevocable” next to the name of the
beneficiary on the form. If a beneficiary is named as irrevocable, the beneficiary designation cannot be changed without the
consent of the irrevocable beneficiary. Any irrevocable beneficiary must sign this and any subsequent beneficiary change requests.
The irrevocable beneficiary may be required to sign other requests for changes to, or disbursements from, the policy.
TRUST/MINOR BENEFICIARIES: If a trust is named beneficiary, the Company shall not be responsible for the disposition by
the trustee of any proceeds paid to the trustee. Any payment to a minor beneficiary shall be made to the legally appointed guardian
of the estate or conservator of the minor, unless otherwise permitted by law.
PER STIRPES DESIGNATIONS: A per stirpes designation will direct death benefits to lineal descendants of the beneficiary if
the beneficiary is not living at the time of claim. You may wish to seek legal counsel regarding use of per stirpes designations.
PERCENTAGES: Please do not specify dollar amounts. Use percentages totaling 100% for primary and contingent designations.
Primary beneficiaries should total 100% and contingent beneficiaries should independently total 100%.
TRUST: John Doe Revocable Trust, dated 01/01/1999
IRREVOCABLE BENEFICIARY: Jane Doe, Irrevocable
CORPORATE CREDITOR: ABC Co., Inc., Cr
editor
, a California Corporation, its successors and assigns, as its interest may
appear; remainder, if any, to Jane Doe, Spouse
TRUSTEE UNDER LAST WILL AND TESTAMENT: Testamentary trust under the Last Will and Testament of NAME, if
created under the will; otherwise, _________________(estate, individual, etc)”.
PER STIRPES DESIGNATIONS: John Doe 50%, per stirpes and Jane Doe 50%, per stirpes
Section A: Instructions and Si
g
nature Re
q
uirements
Section B: Sam
p
le Beneficiar
y
Desi
g
nations
REV 10/15
Reset Form
Transamerica Life Insurance Company
Transamerica Premier Life Insurance Company
Fax Number 1-800-235-4782
Administrative Office located at: 4333 Edgewood Rd. NE, Cedar Rapids, IA 52499
1
BEN-CCC 02/14
Beneficiary
Change Form
P
olicy Number(s)_____________________________________ Owner_________________________________________
Owner Address ______________________________________City/State/Zip ____________________________________
Insured ____________________________________________ Insured Phone No. ________________________________
Insured Social Security No.______________________ Insured Birth Date _______________________________________
Insured Address ______________________________________City/State/Zip ____________________________________
• Primary beneficiary: Receives any proceeds payable at the insured’s death.
• The policy’s death benefit will be paid to multiple beneficiaries in equal shares unless otherwise indicated.
• If additional space is needed, please write “See attached” on this form and attach an additional page. Please sign and
date this form as well as the additional page(s).
Primary Beneficiary(ies)
If this section is left blank, the primary beneficiary will remain as currently listed on policy.
Name _________________________________________________________________________________________
Relationship _________________________________________________ Birth or Trust Date________________
Address ______________________________________________________________________________________
City/State/Zip _________________________________________________________________________________
Phone Number___________________________________ SSN or Tax ID Number ________________________
share equally
OR
________%
Name _________________________________________________________________________________________
Relationship _________________________________________________ Birth or Trust Date________________
Address ______________________________________________________________________________________
City/State/Zip _________________________________________________________________________________
Phone Number___________________________________ SSN or Tax ID Number ________________________
share equally
OR
________%
Name _________________________________________________________________________________________
Relationship _________________________________________________ Birth or Trust Date________________
Address ______________________________________________________________________________________
City/State/Zip _________________________________________________________________________________
Phone Number___________________________________ SSN or Tax ID Number ________________________
share equally
OR
________%
Name _________________________________________________________________________________________
Relationship _________________________________________________ Birth or Trust Date________________
Address ______________________________________________________________________________________
City/State/Zip _________________________________________________________________________________
Phone Number___________________________________ SSN or Tax ID Number ________________________
share equally
OR
________%
Primary Beneficiary Percentage Total (must equal 100%)
_________%
Section 1: Policy Information
Section 2: Primary Beneficiary Information (If completed, revokes prior designations)
Transamerica Life Insurance Company
Transamerica Premier Life Insurance Company
Fax Number 1-
800-235-4782
Administrative Office located at: 4333 Edgewood Rd. NE, Cedar Rapids, IA 52499
2
BEN-CCC 02/14
Beneficiary
Change Form
• Contingent beneficiary: Receives proceeds only if no primary beneficiary(ies) survives the insured.
• Primary and contingent beneficiaries cannot be the same.
Contingent Beneficiary(ies)
If this section is left blank, current contingent beneficiary designations will be revoked.
Name _________________________________________________________________________________________
Relationship _________________________________________________ Birth or Trust Date________________
Address ______________________________________________________________________________________
City/State/Zip _________________________________________________________________________________
Phone Number___________________________________ SSN or Tax ID Number ________________________
share equally
OR
________%
Name _________________________________________________________________________________________
Relationship _________________________________________________ Birth or Trust Date________________
Address ______________________________________________________________________________________
City/State/Zip _________________________________________________________________________________
Phone Number___________________________________ SSN or Tax ID Number ________________________
share equally
OR
________%
Name _________________________________________________________________________________________
Relationship _________________________________________________ Birth or Trust Date________________
Address ______________________________________________________________________________________
City/State/Zip _________________________________________________________________________________
Phone Number___________________________________ SSN or Tax ID Number ________________________
share equally
OR
________%
Name _________________________________________________________________________________________
Relationship _________________________________________________ Birth or Trust Date________________
Address ______________________________________________________________________________________
City/State/Zip _________________________________________________________________________________
Phone Number___________________________________ SSN or Tax ID Number ________________________
share equally
OR
________%
Contingent Beneficiary Percentage Total (must equal 100%)
_________%
PLEASE SIGN AND DATE FORM ON PAGE 3
Section 3: Contingent Beneficiary Information
Transamerica Life Insurance Company
Transamerica Premier Life Insurance Company
Fax Number 1-800-235-4782
Administrative Office located at: 4333 Edgewood Rd. NE, Cedar Rapids, IA 52499
3
BEN-CCC 02/14
Beneficiary
Change Form
**Please Note: All policy owners must sign this Beneficiary Designation Form.
If this form is recorded by the Company, such recording does not mean that the Company has passed on the legal
adequacy or validity of the change. Please consult your own legal or tax advisor for any such determination.
Unless we have been notified of a community or marital property interest in this policy, we will assume that no such
interest exists and will assume no responsibility for inquiring whether such interest exists. By signing this form, the
policy owner agrees to indemnify and hold us harmless from the consequences of making the changes requested in this
document.
Owner Signature _____________________________________________ Date ___________________
(Required)
Joint Owner Signature ____________________________________________ Date ___________________
(if applicable)
Joint Owner Signature _____________________________________________ Date ___________________
(if applicable)
Witness Signature (only required in MA) ______________________________________ Date _____________________
*Signature of the policy owner in MA must be witnessed by someone over the age of 18, not related to the policy owner(s), and not a named
beneficiary.
If you have designated a beneficiary as irrevocable, the irrevocable beneficiary must sign this form. The irrevocable
beneficiary must also sign any future beneficiary change requests. Please see Instructions.
Signature of Irrevocable Beneficiary: __________________________________ Date __________________
(if applicable)
A confirmation of the change will be mailed to the owner’s address of record, unless one of the below options is
selected. If there is more than one owner, please designate one email address or fax number.
By selecting the email or fax option below, I understand that confirmation will not be sent in paper form.
____ I would like confirmation of this change, or any questions related to the requested change, securely emailed
to me at the email address provided below.
Email Address (Print)_____________________________________________________________________________
____ I would like confirmation of this change, or any questions related to the requested change, faxed to the fax
number below.
Fax Number_____________________________________________________________________________________
Section 4: Signatures and Date
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Beneficiary Change Form Section A: Instructions and Si (Transamerica)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 9 August 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document