UNITED STATES DEPARTMENT OF AGRICULTURE Rural Utilities Service BULLETIN 1780-26 SUBJECT: Guidance for the Use of Engineers Joint Contract Documents Committee (EJCDC) Documents on Water and Waste
rus 1780 26

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What is a Change of Beneficiary Request Form?

The Change of Beneficiary Request Form is a document completed and filed by an insured individual who wants change an insurance beneficiary. In this case a beneficiary is a person who receives all payments according to the health insurance policy. The change is possible if it is within the law of the state.

What is the Change of Beneficiary Request Form for?

The main purpose of this form is to claim a change of the insurance beneficiary. The change of the beneficiary in the insurance agreement may be arranged only after the written approval of the insured individual and insurer. The beneficiary cannot be changed by another party after meeting certain requirements according to the insurance agreement and providing a claim about a disbursement of the insurance amount to the insurer.

When is the Change of Beneficiary Request Form Due?

The request does not have a certain due date. It may be different in different insurance companies and institutions.

What Information do I Include in the Change of Beneficiary Request Form?

The form consists of three sections. Section A is called the Policy Information. You must indicate the policy number, the name of the insured and the name of the policy owner. In Section B that is called the Beneficiary’s Information you must provide such information as the name, address, social security number, date of birth, relationship to the insured and the percentage. The same details must be indicated in Section D concerning the contingent beneficiary information. Section D is aimed at signatures and the date.

Where do I Send the Change of Beneficiary Request Form?

If your request form is fully completed, send it to the following address:

The Hartford
Individual Life Division
PO Box 64582
St. Paul, MN 55164-0582

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