Transcription of Beneficiary Designation for Life Insurance - UHC
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Beneficiary Designation for Life Insurance - UHC
Beneficiary Form Group Term life Insurance Important Note: This Beneficiary Designation cancels any prior Beneficiary Designation and shall be effective on the date received by the Company Policyholder: Individual Covered Person SSN# and DOB: Phone#. Street Address (please include apartment # as City State Zip applicable). THE Beneficiary FOR THE POLICY SHALL BE: Primary Beneficiary % of Death Relationship to the Benefit Payable to Name Address SSN# and DOB. Covered Person Beneficiary (must total 100%). In the event, and only in the event, that all Primary Beneficiaries predecease me, then the proceeds shall be payable to the following Contingent Beneficiaries Contingent Beneficiary % of Death Relationship to the Benefit Payable to Name Address SSN# and DOB.
Group Term Life Insurance 100-12711 - Important Note: This Beneficiary Designation cancels any prior beneficiary designation and shall be effective on the date received by the Company Policyholder: Individual Covered Person SSN# and DOB: Phone# Street Address (please include apartment # as applicable) City State Zip
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