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The Lifesecure Beneficiary Change form is a crucial document for policyholders looking to update their designated beneficiaries. It allows individuals to specify both primary and contingent beneficiaries, ensuring that the right people receive benefits in the event of the policyholder's passing. The form requires detailed information, including the full legal names, social security numbers, and relationships of the beneficiaries to the insured. Additionally, it provides options for naming a trust as a primary beneficiary, which can offer further estate planning benefits. Important clauses, such as the postponed clause and per stirpes designation, allow policyholders to customize how benefits are distributed under certain circumstances. Completing this form accurately is essential, as any errors could lead to delays or complications in benefit distribution. Policyholders must also ensure that their signatures are witnessed by a responsible adult who is not a relative or beneficiary. This form must be submitted to LifeSecure Insurance Company, and it is vital to keep a copy for personal records. Updating beneficiary information should not be taken lightly, as it can significantly impact the financial security of loved ones.

Lifesecure Beneficiary Change Example

Administrative Office:

PO Box 19085

Greenville, South Carolina 29602-9085

Telephone: 800-880-1370  Fax: 888-232-1676

BENEFICIARY CHANGE FORM

Instructions on back

PLEASE PROVIDE YOUR SOCIAL SECURITY NUMBER WHERE INDICATED

POLICY / CONTRACT NUMBER:

INSURED / ANNUITANT:

SOCIAL SECURITY #:

 

 

 

 

 

OWNER:

SOCIAL SECURITY #:

 

1. PRIMARY BENEFICIARY (IES)

 

 

 

 

RELATIONSHIP

DATE OF

FULL NAME, ADDRESS & SOCIAL SECURITY #

 

TO INSURED

BIRTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTINGENT BENEFICIARY (IES)

RELATIONSHIP

DATE OF

FULL NAME, ADDRESS & SOCIAL SECURITY #

TO INSURED

BIRTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UNLESS OTHERWISE DIRECTED PROCEEDS WILL BE PAID IN EQUAL SHARES TO ANY PRIMARY BENEFICIARIES WHO SURVIVE THE INSURED, BUT IF NONE SURVIVE, PROCEEDS WILL BE PAID IN EQUAL SHARES TO ANY CONTINGENT BENEFICIARIES WHO SURVIVE THE INSURED.

2. TRUST AS PRIMARY BENEFICIARY

 

 

 

__________________________________________

_________________________

__________________________________

 

(NAME OF TRUST)

(TRUST TAX I.D. NUMBER)

(CURRENT TRUSTEE)

 

OR ANY SUCCESSOR OR SUCCESSORS IN TRUST UNDER AGREEMENT DATED (MM/DD/YY)

,

AND ANY AMENDMENTS THERETO, OR IF THE TRUST IS TERMINATED, TO THE OWNER, OR THE ESTATE OF THE OWNER.

PLEASE PROVIDE A COPY OF THE FIRST AND LAST PAGE OF TRUST ESTABLISHING TRUSTEE AND DATE.

EITHER ONE OR BOTH OF THE FOLLOWING MAY BE SELECTED IF DESIRED.

A. POSTPONED CLAUSE - IN NO CASE SHALL ANY PAYMENT BE MADE TO ANY BENEFICIARY DESIGNATED ON THIS

FORM UNTIL MIDNIGHT OF THE 30TH DAY FOLLOWING DEATH, AND IN THE EVENT OF THE DEATH OF A BENEFICIARY DURING SUCH PERIOD, PAYMENT SHALL BE MADE IN THE SAME MANNER AS PROVIDED IN THIS FORM HAD SAID BENEFICIARY PREDECEASED THE INSURED. THIS PROVISION SHALL NOT APPLY TO A TRUSTEE.

B. PER STIRPES - IF A BENEFICIARY PREDECEASES THE INSURED, LEAVING CHILDREN WHO SURVIVE THE INSURED, THE SHARE SUCH DECEASED BENEFICIARY WOULD HAVE RECEIVED HAD SUCH BENEFICIARY SURVIVED THE INSURED SHALL BE PAID IN EQUAL SHARES TO THE SURVIVING CHILDREN OF SUCH DECEASED BENEFICIARY.

LifeSecure Insurance Company (Formerly Columbia Universal Life)

55-23 R1204 LS BENE CHANGE FORM Page 1 of 2

I DIRECT THAT ANY ENDORSEMENT OF THE POLICY REQUESTED BE EFFECTED BY RETURN OF THIS REQUEST WITH THE COMPANY'S ACKNOWLEDGMENT. I AGREE THAT THE COMPANY MAY WAIVE ANY POLICY PROVISION REQUIRING PRESENTATION ON THE POLICY FOR ENDORSEMENT, BUY MAY REQUIRE SUCH PRESENTATION IF DESIRED.

DATED AT

THIS

DAY OF

, 20_____

 

 

_______________________________________________

WITNESS (PLEASE SEE BELOW*)

 

SIGNATURE OF POLICY/CONTRACT OWNER

 

 

(IF OWNED BY A COMPANY, NEED TWO SIGNATURES

 

 

AND INCLUDE TITLE

 

THE UNDERSIGNED AGREES TO THE ABOVE REQUESTS AND CHANGES

 

 

 

SIGNATURE OF IRREVOCABLE BENEFICIARY (IF ANY)

SIGNATURE OF ASSIGNEE, INCLUDE TITLE (IF ANY)

 

FOR ADMINISTRATIVE OFFICE USE ONLY

ACKNOWLEDGMENT OF REQUEST FOR CHANGE - PLEASE ATTACH TO POLICY

THE ABOVE COMPANY HAS RECORDED THE CHANGE REQUESTED

DATED AT GREENVILLE, SOUTH CAROLINA

 

BY

 

 

 

*BE SURE TO HAVE THE POLICYOWNER'S SIGNATURE WITNESSED BY SOMEONE WHO IS NOT A RELATIVE OR BENEFICIARY

INSTRUCTIONS FOR CHANGING BENEFICIARY

THE FULL LEGAL NAME AND RELATIONSHIP TO THE INSURED OF EACH PRIMARY AND CONTINGENT BENEFICIARY IS TO BE CLEARLY SHOWN. FOR EXAMPLE, MARTHA BROWN SMITH (WIFE) AND NOT MRS. JOHN H. SMITH (WIFE).

IF THE POLICY IS ASSIGNED, THE ASSIGNEE MUST JOIN IN SIGNING THE CHANGE OF BENEFICIARY AGREEMENT. THE CHANGE OF BENEFICIARY AGREEMENT MUST BE DATED, AND YOUR SIGNATURE AND THAT OF THE ASSIGNEE MUST BE WITNESSED BY A RESPONSIBLE ADULT.

ALL SIGNATURES ARE TO BE IN INK. THE CHANGE WILL BE RECORDED BY US AND A COPY WILL BE RETURNED TO THE OWNER. PLEASE DO NOT SEND US YOUR POLICY.

THE POLICYOWNER REVOKES ANY PREVIOUS DESIGNATION OF BENEFICIARY AND METHOD OF SETTLEMENT FOR THE POLICY. RECORDING THE INSTRUMENT THE COMPANY AGREES, THAT THE CHANGE OF BENEFICIARY REQUESTED SHALL BECOME EFFECTIVE UPON RECEIPT AND RECORDING OF THIS PROPERLY COMPLETED FORM BY THE COMPANY, DURING THE LIFETIME OF THE INSURED, AT ITS HOME OFFICE IN AUSTIN, TEXAS; AND SUBJECT TO THE PROVISIONS OF THE POLICY.

WHEN MORE THAN ONE PRIMARY BENEFICIARY IS NAMED, PAYMENT SHALL BE MADE SHARE AND SHARE ALIKE, SURVIVORS AND SURVIVOR. THIS SIMILARLY APPLIES WHEN MULTIPLE CONTINGENT BENEFICIARIES ARE NAMED AND BECOME ENTITLED TO THE PROCEEDS OF THIS POLICY.

IF A CHANGE OF BENEFICIARY IS DESIRED ON MORE THAN ONE POLICY, COMPLETE A SEPARATE FORM FOR EACH POLICY. FOR EACH INSURED COVERED UNDER ONE POLICY, COMPLETE A SEPARATE FORM.

PLACE AN "X" IN ONLY ONE OF THE BOXES NUMBERED 1 OR 2 AND INDICATE THE DESIRED BENEFICIARY IN THE SPACE PROVIDED. IF MORE THAN ONE BOX IS MARKED, THE FORM WILL BE RETURNED FOR CLARIFICATION AND PROCESSING WILL BE DELAYED. GIVE THE FULL NAME (FIRST NAME, MIDDLE INITIAL, AND LAST NAME) AND ADDRESS OF THE DESIRED BENEFICIARY (IES) AND THE RELATIONSHIP, IF ANY, OF EACH TO THE INSURED AND THE DATE OF BIRTH. FOR DESIGNATION NUMBER 2, PROVIDE THE TRUST NAME AND GIVE THE DATE OF THE TRUST AGREEMENT.

IMPORTANT:

PLEASE PROVIDE THE NAME, ADDRESS, SOCIAL SECURITY NUMBER AND THE RELATIONSHIP TO THE INSURED FOR EACH BENEFICIARY, OR IF THE CLASS OF BENEFICIARIES IS NAMED, THE NAME OF EACH CURRENT BENEFICIARY IN THE CLASS.

55-23 0901 LS BENE CHANGE FORM

Page 2 of 2

File Breakdown

Fact Name Fact Details
Administrative Office PO Box 19085, Greenville, South Carolina 29602-9085
Contact Information Telephone: 800-880-1370, Fax: 888-232-1676
Social Security Requirement Social Security numbers must be provided for all parties involved.
Beneficiary Designation Primary and contingent beneficiaries must be clearly named with their relationship to the insured.
Trust as Beneficiary If a trust is named, provide the trust name, tax ID number, and current trustee.
Postponed Clause Payments to beneficiaries may be delayed until 30 days after the insured's death.
Per Stirpes Provision If a beneficiary predeceases the insured, their share goes to their surviving children.
Signature Requirements All signatures must be in ink and witnessed by a non-relative or beneficiary.
Governing Law For South Carolina: South Carolina Code of Laws, Title 62 (Probate Code).

Guide to Using Lifesecure Beneficiary Change

Completing the Lifesecure Beneficiary Change form is an important step in ensuring that your wishes are clearly documented. Once the form is filled out accurately, it should be submitted to the Lifesecure Administrative Office for processing. Below are the steps to guide you through filling out the form correctly.

  1. Begin by providing your Social Security Number in the indicated space.
  2. Enter the Policy/Contract Number, Insured/Annuitant's full name, and their Social Security Number.
  3. Fill in the Owner's full name and Social Security Number.
  4. For the Primary Beneficiary section, list the full name, address, relationship to the insured, and date of birth for each primary beneficiary.
  5. For the Contingent Beneficiary section, provide the same information as above for each contingent beneficiary.
  6. If designating a Trust as a primary beneficiary, fill in the trust's name, tax ID number, and current trustee's name. Also, include the date of the trust agreement.
  7. If desired, select either option A (Postponed Clause) or option B (Per Stirpes) by marking the appropriate box.
  8. Sign and date the form in the designated area. If the policy is owned by a company, ensure that two signatures are provided along with titles.
  9. If there is an irrevocable beneficiary, include their signature as well.
  10. Have your signature witnessed by someone who is not a relative or beneficiary.

After completing the form, it should be submitted to the Lifesecure Administrative Office at the address provided. The changes will be recorded and a confirmation copy will be sent back to you. Be sure to keep a copy for your own records.

Get Answers on Lifesecure Beneficiary Change

What is the purpose of the LifeSecure Beneficiary Change form?

The LifeSecure Beneficiary Change form is designed to allow policyholders to update or change the designated beneficiaries of their insurance policy. This form ensures that the proceeds from the policy are distributed according to the policyholder's current wishes in the event of their death. It is essential to keep beneficiary information up to date, as changes in personal circumstances, such as marriage, divorce, or the birth of a child, may necessitate a revision of beneficiary designations.

How do I complete the Beneficiary Change form?

To complete the Beneficiary Change form, follow these steps:

  1. Provide your Social Security number, policy or contract number, and the names of the insured and owner, along with their Social Security numbers.
  2. Clearly list the full legal names, addresses, and relationships of each primary and contingent beneficiary. It is important to avoid using informal names or titles.
  3. If designating a trust as a beneficiary, include the trust's name, tax identification number, and the current trustee's name.
  4. Choose any additional clauses, such as a postponed clause or per stirpes distribution, if desired.
  5. Sign the form, ensuring that your signature is witnessed by a responsible adult who is not a relative or beneficiary.

After completing the form, submit it to the administrative office at the address provided on the form. Do not send the policy itself.

What happens after I submit the Beneficiary Change form?

Once the LifeSecure administrative office receives the properly completed Beneficiary Change form, they will record the changes. The change becomes effective immediately upon receipt and recording by the company, as long as it is done during the lifetime of the insured. A confirmation copy will be sent back to the policy owner for their records. It is important to note that any previous beneficiary designations will be revoked upon recording the new changes.

Can I designate multiple beneficiaries on the form?

Yes, you can designate multiple primary and contingent beneficiaries on the LifeSecure Beneficiary Change form. When multiple beneficiaries are named, the proceeds will be distributed equally among them, unless otherwise specified. It is crucial to ensure that only one of the beneficiary designation options is selected—either primary or contingent—to avoid confusion and delays in processing. If you wish to change beneficiaries on multiple policies, a separate form must be completed for each policy.

Common mistakes

Filling out the Lifesecure Beneficiary Change form can be straightforward, but several common mistakes can lead to complications. One frequent error is not providing the full legal name of the beneficiaries. It's essential to write the complete name, including the first name, middle initial, and last name. For example, using "Martha Brown Smith" instead of "Mrs. John H. Smith" is critical for clarity.

Another mistake involves omitting the social security numbers of the beneficiaries. This information is necessary for identification purposes. Failing to include it can delay the processing of the form or result in issues when trying to claim the benefits.

People often forget to specify the relationship of each beneficiary to the insured. This detail is crucial. Without it, the insurance company may have difficulty determining the rightful beneficiaries, potentially leading to disputes among family members.

Using incorrect or outdated addresses for beneficiaries is also a common pitfall. It's important to ensure that the address is current and complete. An incorrect address can result in important documents not reaching the intended recipient.

Many individuals neglect to sign and date the form properly. All signatures must be in ink, and the date is vital for processing. If the form is not signed correctly, it may be returned, causing delays in the beneficiary change.

Another oversight is failing to have the signature of the policy owner witnessed. The witness should not be a relative or beneficiary. This step adds an extra layer of validity to the form and is often a requirement for processing.

People sometimes check more than one box when indicating the type of beneficiary. Only one box should be selected—either primary or contingent. Marking both can lead to confusion and delay in processing the request.

Lastly, not providing the trust name and date of the trust agreement when designating a trust as a beneficiary can create issues. This information is essential for the insurance company to understand the terms of the trust and to process the request accurately.

Documents used along the form

When you are updating your beneficiary information, there are several other important documents that may be needed alongside the Lifesecure Beneficiary Change form. Each of these documents serves a specific purpose in ensuring that your wishes are clearly communicated and legally recognized. Below is a list of commonly used forms and documents.

  • Life Insurance Policy: This document outlines the terms of the insurance coverage, including the insured amount and any exclusions. It is essential for verifying the details of the policy.
  • Trust Documents: If a trust is named as a beneficiary, the trust agreement must be provided. This includes the name of the trust, its tax identification number, and the current trustee’s information.
  • Power of Attorney: This document grants someone the authority to act on your behalf in financial or legal matters. It may be necessary if the policy owner is unable to make decisions.
  • Will: A will outlines how your assets will be distributed upon your death. It can clarify your intentions regarding beneficiaries and may be referenced in beneficiary designations.
  • Assignment of Benefits Form: If the policy has been assigned to another party, this form indicates the rights of the assignee and must be included with the beneficiary change.
  • Identification Documents: Copies of government-issued IDs for the policy owner and beneficiaries may be required to verify their identities.
  • Change of Ownership Form: If the ownership of the policy is being transferred, this form must be completed to ensure the new owner is recognized.
  • Medical Release Form: If the insurance company requires medical information to process the beneficiary change, this form allows them to obtain necessary health records.
  • Affidavit of Surviving Spouse: This document may be needed if a spouse is designated as the beneficiary and there are questions about the marital status at the time of death.

Ensuring that all necessary documents are submitted with the Lifesecure Beneficiary Change form can help prevent delays in processing your request. It's crucial to keep your beneficiary designations up to date to reflect your current wishes and circumstances.

Similar forms

The Lifesecure Beneficiary Change form serves an important role in estate planning and insurance management. Several other documents share similarities with this form in terms of purpose and functionality. Below is a list of these documents and how they relate to the Lifesecure Beneficiary Change form.

  • Last Will and Testament: Like the Beneficiary Change form, a will specifies how an individual's assets will be distributed after their death. Both documents allow individuals to dictate their wishes regarding who will receive their property.
  • Trust Document: A trust document establishes a legal entity that holds assets for beneficiaries. Similar to the Beneficiary Change form, it designates who will benefit from the assets and under what conditions, often providing more control over distributions.
  • Power of Attorney: This document grants someone the authority to make decisions on behalf of another individual. While it focuses on decision-making rather than asset distribution, it shares the goal of ensuring that an individual's wishes are respected in their absence.
  • Healthcare Proxy: A healthcare proxy allows someone to make medical decisions for another person if they are unable to do so. Like the Beneficiary Change form, it ensures that personal preferences are honored, but in the context of health care rather than financial assets.
  • Beneficiary Designation Form for Retirement Accounts: This form allows individuals to designate beneficiaries for retirement accounts, similar to how the Lifesecure form designates beneficiaries for insurance policies. Both documents ensure that assets pass directly to named individuals upon death.
  • Transfer on Death Deed: This deed allows property owners to transfer real estate to beneficiaries upon their death without going through probate. Like the Beneficiary Change form, it simplifies the transfer process and specifies who receives the asset.
  • Life Insurance Policy: The policy itself includes sections for naming beneficiaries, much like the Lifesecure form. Both documents are crucial in determining who will receive the insurance payout upon the policyholder's death.

Dos and Don'ts

When filling out the LifeSecure Beneficiary Change form, it is essential to follow certain guidelines to ensure accuracy and compliance. Below is a list of things you should and should not do:

  • Do provide your Social Security number where indicated.
  • Do clearly write the full legal name of each beneficiary, including first name, middle initial, and last name.
  • Do include the relationship of each beneficiary to the insured.
  • Do ensure that all signatures are in ink and witnessed by a responsible adult.
  • Do complete a separate form for each policy if multiple policies are involved.
  • Don't mark more than one box for beneficiary designation; doing so will delay processing.
  • Don't send your policy with the form; it is not required.
  • Don't use abbreviations or informal names for beneficiaries; use their full legal names.
  • Don't forget to provide the date of birth for each beneficiary listed.

Misconceptions

Understanding the Lifesecure Beneficiary Change form can be challenging, and several misconceptions often arise. Here are eight common misunderstandings along with clarifications to help clear the air:

  • Misconception 1: The form can be submitted without a witness.
  • In fact, the signature of the policy or contract owner must be witnessed by someone who is not a relative or beneficiary. This ensures the validity of the request.

  • Misconception 2: You can name multiple primary beneficiaries without specifying shares.
  • When multiple primary beneficiaries are named, the proceeds will be paid in equal shares to those who survive the insured. It's essential to clarify this on the form.

  • Misconception 3: The form is effective immediately upon submission.
  • The change becomes effective only after the properly completed form is received and recorded by the company at its home office. Until then, the previous designation remains in place.

  • Misconception 4: You must send the policy document along with the form.
  • This is incorrect. You do not need to send the policy; simply complete and submit the form.

  • Misconception 5: You can use nicknames for beneficiaries.
  • It is crucial to provide the full legal name of each beneficiary. For example, use "Martha Brown Smith" instead of "Martha" or "Mrs. John H. Smith."

  • Misconception 6: The form does not require social security numbers for beneficiaries.
  • On the contrary, it is necessary to include the social security number of each beneficiary to ensure accurate identification and processing.

  • Misconception 7: Changes can be made verbally over the phone.
  • Changes must be submitted in writing using the official form. Verbal requests cannot be processed.

  • Misconception 8: The form allows for changes to be made retroactively.
  • Changes to beneficiaries cannot be applied retroactively. They take effect only from the date the company records the completed form.

By understanding these common misconceptions, individuals can navigate the Lifesecure Beneficiary Change form more effectively and ensure their wishes are accurately reflected.

Key takeaways

Here are some key takeaways for filling out and using the Lifesecure Beneficiary Change form:

  • Provide your Social Security Number. Make sure to include it where indicated on the form.
  • Include policy details. Fill in the policy or contract number, insured or annuitant's name, and their Social Security number.
  • Clearly state beneficiary information. Provide the full legal name, address, and relationship to the insured for each primary and contingent beneficiary.
  • Use correct naming conventions. For example, write "Martha Brown Smith (Wife)" instead of "Mrs. John H. Smith (Wife)."
  • Trusts as beneficiaries. If designating a trust, include the trust name, tax ID number, and current trustee’s name.
  • Witness signatures. Ensure that the policyowner's signature is witnessed by someone who is not a relative or beneficiary.
  • Keep it neat. Use ink for all signatures and avoid any alterations on the form.
  • Submit only the completed form. Do not send your policy along with the form; just the form is required.
  • One form per policy. If you have multiple policies, fill out a separate form for each one.
  • Clarify any multiple selections. Mark only one of the boxes for primary or contingent beneficiaries to avoid delays.

Following these guidelines will help ensure that your beneficiary change request is processed smoothly and efficiently.