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Change of Beneficiary Form - Template, Sample Form

✓ Valid in United States

Create your Change of Beneficiary Form - Template, Sample Form for use in United States. Answer a few plain-English questions and the document fills in automatically as you go — then download it in Word and PDF, ready to sign or share.

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Change of Beneficiary Form - Template, Sample Form
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________
________
Email: ________


Date: ________



________
________
Email: ________


RE: Insurance Policy Number: ________/Owner: ________/Insured: ________


To whom it may concern:

I am writing to make a change to the insurance policy described above. For reference, the policy number is: ________.

There should be a change made to the primary beneficiary. The primary beneficiary will still be the same individual, but their name has legally changed. The prior name was as follows: ________. The new legal name is as follows: ________. This name change is made due to marriage.

Sincerely,


________

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