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GROUP TERM LIFE INSURANCE BENEFICIARY DESIGNATION

GR-TR-BENE-MET1-SOC74503 Page 1 of 4 (03/19) Fs/fGroup Term life INSURANCE BENEFICIARY DESIGNATION Use this form to name the persons or entities you want to receive your life INSURANCE proceeds after your death. Metropolitan life INSURANCE Company Things to know before you begin Completing this form replaces your existing BENEFICIARY designations . Please provide details for each BENEFICIARY , even if you have already given us this information in the past. Gather the name(s), date(s) of birth, Social Security/Tax ID number(s) and contact information for all of your beneficiaries. The beneficiaries you name on this form apply to your GROUP Term life INSURANCE coverage insured by metlife . To name additional beneficiaries, attach a separate page. Provide the requested information including the BENEFICIARY type (primary or contingent) and the % proceeds for each.

SECTION 1: About the Insured. First name Middle name Last name Date of birth (mm/dd/yyyy) Social Security number Phone number Address City State ZIP Employer name Customer number. SECTION 2: About the Plan . The beneficiaries you name on this form apply only to the MetLife-insured plan(s) selected below: All group term life coverage currently ...

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AUTHORIZATION AGREEMENT FOR AUTOMATIC ... - …

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