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Beneficiary - Americo

Administrative Office: PO Box 410288, kansas City, MO 64141-0288 Phone Fax Email Documents 18-164-1 (11/21) Page 1 of 3 Beneficiary Change Request 18-164-1 (11/21) The following is provided to assist you in designating a new Beneficiary . Please read the instructions carefully. If you have any questions, call or email us at If alterations have been made, the owner must initial by any changes. If you wish to email the completed documents: IS A NOTARY REQUIRED? A Notary is highly recommended. If this document is not notarized and signatures do not appear to match, a notary will be required by us to approve. WHO MAY NAME OR CHANGE THE Beneficiary ON A POLICY?

Administrative Office: PO Box 410288, Kansas City, MO 64141-0288Change Request Phone 800.231.0801 Fax 800.395.9238 Email Documents forms@americo.com 18-164-1 (11/21) Page 1 of 3. Beneficiary . 18 -164 1( /2 ) The following is provided to assist you in designating a new Beneficiary. Please read the instructions carefully. If you have any questions,

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