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Application for Change of Beneficiary

Application for Change of Beneficiary Mutual of Omaha Insurance Company and Insurance Affiliates* Mutual of Omaha Plaza Omaha, NE 68175 *United of Omaha Life Insurance Company United World Life Insurance Company Omaha Insurance Company Instructions for Completing the Change of Beneficiary Form The Change of Beneficiary Form is attached. Examples of wording that can be used to designate a Beneficiary on this Form are set forth below. If the policy proceeds are to be paid other than in a single sum, do not use this form and contact United of Omaha Life Insurance Company for further instructions.

Instructions for Signing the Change of Beneficiary Form . Who Must Sign: The Change of Beneficiary Form must be signed by the person or persons who, under the terms of the policy, have the right to change the beneficiary. If the previous beneficiary was designated as an irrevocable beneficiary, that irrevocable beneficiary must also sign.

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