Ownership Change and Beneﬁciary Designation
Instructions and Guidelines
GNWOwnBen INST 12/13/13
Genworth Life and Annuity Insurance Company, Richmond, VA
Genworth Life Insurance Company, Richmond, VA
Genworth Life Insurance Company of New York, New York, NY
Only Genworth Life Insurance Company of New York is admitted in and conducts business in New York.
Please follow these instructions carefully when submitting
a form to prevent any delays caused by unclear or
missing information. Be sure to read and ﬁll out the form
completely and return all pages. This instruction page
does not need to be returned to us.
1. Print clearly! Cross-through, initial and date any
corrections or changes. Do not use correction ﬂuid.
2. We require a speciﬁc version of the form if your policy
was delivered in LA, MD, ME, NH, OH, VA, VT or WA. Be
sure you are using the correct version for your requests.
3. Ownership changes may have tax consequences.
Contact your tax or legal advisor to discuss your speciﬁc
4. The Certiﬁcation of Trustee Powers section must
be completed for any trust designated as owner or
5. Please allow 7-10 business days processing time. After
receipt of your properly completed form, we will send
written conﬁrmation of the change.
1. If the owner is changed, any contingent owner is
automatically revoked and must be restated.
2. An ownership change revokes any prior electronic funds
transfer (EFT) authorization. To continue EFT, you must
complete the EFT section and the bank account owner
must sign the authorization on page 2.
3. Answer the U.S. citizen question and provide the
Permanent Resident Card or Visa number if applicable
for any individual designated as owner.
4. Complete the Business information section for any
business designated as owner.
1. A beneﬁciary change revokes all prior beneﬁciary
designations. You must restate the primary beneﬁciary
in the primary beneﬁciary section, even if you only want
to change or add a contingent beneﬁciary.
2. If you wish to designate more than four beneﬁciaries
attach a signed and dated sheet listing additional
beneﬁciaries including all details as indicated in
Beneﬁciary Designation section.
1. Please review and follow the instructions below carefully,
to ensure your request is not delayed.
2. Be sure to have all required parties sign in their capacity
or with title as required.
3. Be sure to review all requirements below and submit any
additional documentation as required.
The attorney-in-fact or Agent must sign in capacity as “attorney-in-fact” or
“Agent”, provide a copy of the entire power of attorney document (if not
previously submitted), and complete and submit a Genworth Declaration
of attorney-in-fact form. An updated Declaration of attorney-in-fact form is
required every 12 months if the power of attorney is durable, otherwise an
updated form is required with each request submitted.
Corporation or Limited Liability Corporation (LLC)
An ofﬁcer of the company or member of the LLC must sign with title (if the
signing ofﬁcer or member is also the insured/annuitant, a second ofﬁcer or
member must also sign), and provide either a corporate or board of director’s
resolution, a copy of the Articles of Incorporation or operating agreement (for
LLCs), or complete the corporate acknowledgement and sign the form in the
presence of a Notary Public.
The guardian must sign in capacity and provide a copy of the guardianship
documents if not previously submitted.
The individual, trustee or representative must sign with the title “Irrevocable
All owners must sign.
All partners must sign with title, or the general or managing partner must
sign with title (if the general or managing partner is also the insured/
annuitant, another partner must also sign).
A spouse in a community property state (AZ, CA, ID, LA, NV, NM, TX, WA, WI)
The trustee(s) must sign with title “trustee,” according to the terms of the
Trust Agreement, and complete the Certiﬁcation of Trustee Powers section if
not previously submitted.
A witness (over 18 years of age) must sign for all life insurance beneﬁciary
changes when the owner resides in Massachusetts.
Genworth, Genworth Financial and the Genworth logo are registered service marks of Genworth Financial, Inc. © 2013 Genworth Financial, Inc. All rights reserved.