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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.

5. Trustee under Last Will and Testament of Insured ..... "Trustee, or successor in Trust, named in the . Last Will and Testament of the Insured; provided, however, that if no Trustee is appointed . within one year of the Insured's death, payment shall be made to the Insured's estate" 6.

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