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4 General Provisions
1. Relationship
The relationship of any beneficiary is to the owner(s) of the annuity contract unless otherwise specified. Standard
Insurance Company may rely on an affidavit or other satisfactory evidence in determining the identity or the
existence of a beneficiary not identified by name.
2. Change of Beneficiary
A beneficiary may be changed at any time while this annuity contract is in force as long as you provide us with a
signed, written notice that we must approve and record in our home office to be effective.
3. Class of Beneficiary
Death benefits will be paid to the beneficiary(ies) named to receive them. When more than one class of beneficiary
is named, payment will be made to those in the highest beneficiary class — the classes ranked in this order: primary,
first contingent, second contingent, etc. Should one beneficiary class include more than one person, any benefit
payable to that class will be paid in equal shares to the surviving beneficiaries of that class unless otherwise provided.
If no beneficiary survives, the death benefit will be paid to the owner(s) of the annuity contract, otherwise to the
owner’s estate (unless the annuity contract provides otherwise).
4. Simultaneous Death
If any beneficiary dies at the same time or within 15 days of the first to die, the owner(s) or the annuitant(s), the
death benefit will be paid as if that beneficiary had died before the owner(s) or the annuitant(s).
5. Benefit Reduced
If a designated beneficiary or class of beneficiaries is to be given a specific dollar amount, but the actual death
benefit is insufficient to pay such stated amount(s) in full, then the benefit payable to each beneficiary in that class
will be reduced proportionately.
6. Claims of Creditors
To the extent permitted by law, amounts payable to a beneficiary shall not be subject to the claims of any creditor or
any representative of such creditor, or to any legal process against a beneficiary.
5 Authorization
I(We) hereby acknowledge that:
1. To be valid, this change must be approved by Standard Insurance Company. I(We) will not hold Standard Insurance
Company legally responsible for any action taken or payment made before they have given approval. Once approved,
the change in beneficiary will take effect on the date I(we) sign this form.
2. I(We) have had ample opportunity to consult with legal counsel on these matters.
3. I(We) am making these changes freely and am relying on my(our) own best judgment.
4. I(We) agree to release and hold Standard Insurance Company harmless from any claims or damages due to the
changes I(we) am making to this annuity contract(s).
5. For owners whose contracts were issued before May 1, 1964 and identified with a number under 216,000: I further
acknowledge that my(our) policy(ies) is hereby changed to include the section on the reverse under General Provisions.
Any of the terms in my(our) contract(s) that conflict with the provisions are hereby changed to conform to the provisions.
6. In no event will Standard Insurance Company be responsible for the application or disposition of funds paid to the
trustee or to any beneficiary. Payment by Standard Insurance Company shall be a full discharge of all liability of
Standard Insurance Company for any amounts so paid.
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OWNER SIGNATURE DATE
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OWNER SIGNATURE DATE
6 Standard Insurance Company accepts the changes set forth above and has recorded them as of the following date.
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AUTHORIZED STANDARD INSURANCE COMPANY HOME OFFICE REPRESENTATIVE SIGNATURE DATE FILED IN PORTLAND, OR
