Change of Beneficiary Form - Template, Sample Form Pro · US-law

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________
Telephone: ________
Email: ________

Date: ________

VIA ________

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Attn: Policyholder Services / Beneficiary Change Department
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Email: ________

RE: Request to Update Beneficiary Name on Insurance Policy
Policy Number: ________
Policy Owner: ________
Insured: ________

To Whom It May Concern:

1. Purpose of Letter. I am writing in my capacity as ________ with respect to the insurance policy identified above (the “Policy”), bearing Policy Number ________, issued by ________ (the “Insurer”). The purpose of this letter is to request that the Insurer update its records to reflect a legal change of name of the primary beneficiary under the Policy.

2. Nature of the Change. This request does not seek to designate a different person as primary beneficiary. The individual designated as the primary beneficiary remains the same; only that individual’s legal name has changed.

3. Prior and New Legal Name. The prior legal name of the primary beneficiary, as currently reflected in the Insurer’s records, is: ________. The new legal name of the same primary beneficiary is: ________.

4. Reason for the Change. The legal name change described above occurred by reason of ________, effective as of ________. For identification purposes, the primary beneficiary’s date of birth is ________ and the last four digits of the beneficiary’s identifying number on file are ________.

5. Supporting Documentation. Enclosed with this letter are copies of documentation evidencing the legal name change, including ________. Should the Insurer require certified copies, original documents, or any specific company form to be completed in order to effectuate this change, please forward the same to the mailing address or email address set forth at the head of this letter, and I will execute and return them promptly.

6. Request for Confirmation. I respectfully request that the Insurer (a) update its records to reflect the primary beneficiary’s new legal name as stated above; (b) confirm in writing, to the address or email at the head of this letter, that the change has been processed; and (c) advise of any additional information or documentation required to complete this request. I further request that the change be processed within ________ of the Insurer’s receipt of this letter.

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Thank you for your prompt attention to this matter.

Sincerely,

______________________________
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Enclosures: ________