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
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
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
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
, 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
Section B: Sam