BENEFICIARY CHANGE INFORMATION SHEET
The following is provided to assist you in designating a new beneficiary.
Things to know before you begin
• This form applies to all companies owned and administrated by Unified Life Insurance Company.
• Only the owner of an insurance policy may name or change the beneficiary. If an irrevocable beneficiary has previously been
named, we must have his or her signature on the change form also.
• If there is more than one Owner, all Owners must sign.
• If the owner of the policy is a trust, signatures and titles of the trustees are required.
• If the owner of the policy is a corporation or business, two company officers’ signatures and titles are required (President, Vice
President, Secretary, etc.).
• This form must reflect all Beneficiaries, both Primary and Contingent, who should receive the proceeds of the policy(ies)
listed below.
• If the Insured dies without a surviving Beneficiary, payment will be made to the Owner, if living, otherwise payment will be made
to the Owner’s Estate.
Definitions
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Owner: The person(s), business, charity, Trust, or entity with the right to make all decisions regarding the policy.
Insured: The person who is insured by the policy(ies) and upon whose death the Beneficiaries will receive the proceeds of
the claim. The Insured may also be the Owner.
Primary Beneficiary: This is the person/party you select to receive life insurance proceeds after the Insured’s death.
Contingent Beneficiary: This is the person/party you select to receive life insurance proceeds after the Insured’s death if no
Primary Beneficiaries survive the Insured.
Testamentary Trust: A Trust created and funded by the Insured’s Will which only becomes active upon the death of the Insured.
Living (Inter Vivos) Trust: A Trust created during the lifetime of the Grantor (person who established the Trust).
FAQs
WHO MAY BE NAMED AS A BENEFICIARY?
The beneficiary may be one person, more than one person, an estate, a trust, a trustee, a corporation, a charitable organization or
any other entity from which the insuring company will be able to obtain a legal receipt for the proceeds.
WHAT IS THE DIFFERENCE BETWEEN A PRIMARY BENEFICIARY AND A CONTINGENT BENEFICIARY?
The PRIMARY beneficiary is the party or parties who will receive the proceeds of the policy when the insured passes away. The
owner of the policy may indicate, by percentage, how the proceeds are to be divided among the parties; if no indication is made
then the proceeds are divided equally among the surviving primary beneficiaries. In the event a beneficiary dies before the insured
and you want the benefits due them to automatically be paid to their next of kin (instead of being divided between any surviving
primary or contingent beneficiaries), please add the phrase “Per Stirpes” after their name on the beneficiary change form.
The CONTINGENT beneficiary will receive the proceeds if the primary beneficiaries should pass away before the person whose life is
insured. The contingent beneficiary will only receive proceeds from the policy if ALL the designated primary beneficiaries have
predeceased the insured. If a beneficiary is not listed, the proceeds are paid to the policy owner, if living, or to the policy owner’s
estate.
HOW DO I NAME A TRUST AS MY BENEFICIARY?
Please provide the name, date and location of the trust where indicated on the Beneficiary Change form.
CAN I NAME MY CHILD AS A BENEFICIARY?
If the policy owner wishes his or her children to receive life insurance proceeds, the children themselves should be named; however,
because benefits are not payable to minors, it is recommended that a trust be established to their benefit. To name a trust as
beneficiary for minor children, we need the name, date and location of the trust.
WHO QUALIFIES AS A DISINTERESTED WITNESS?
Any person who does not have a vested interest in the disbursement of proceeds from the life insurance policy. The best
disinterested witness is a notary public.
ALL FORMS MUST BE SIGNED BY THE CURRENT OWNER AND A DISINTERESTED WITNESS.
SAMPLE BENEFICIARY DESIGNATIONS
Single Person: Joe Travis, husband.
Multiple People: Joe Travis, husband, 75% and Lilly Smith, daughter 25%.
 In this example, if Joe or Lilly were to pass away before the insured their portion of the benefit would automatically pass to
the other named beneficiary.
Multiple People Along Family Lines: Jason Jones (Per Stirpes), Son, 50% and Jillian Smith (Per Stirpes), Daughter 50%
 “Per Stirpes” means that if Jason or Jillian were to pass away before the insured their portion of the benefit would
automatically pass to their next of kin (e.g. spouse, children, grandchildren, etc.) rather than to the other surviving
beneficiary, unless the surviving beneficiaries are themselves the next of kin.
Multiple People by Heirs: Chris Jackson (or his Heirs), Son, 50% and Katy Hopewell (or her Heirs), Daughter 50%
 This designation means that if Chris or Katy were to pass away before the insured their portion of the benefit would
automatically pass to the person(s) named as their heir in their own will/estate rather than to the other surviving
beneficiary, unless the surviving beneficiaries are themselves the heirs. If the heirs are unclear their portion of the benefit
would pass to the beneficiary’s estate, rather than the other surviving beneficiaries.
Minor Beneficiary: Joseph Gregory, a minor, under care of Lucy or Robert Brown, aunt and uncle, until the age of majority.
 If a minor is listed as a beneficiary each state has their own rules that determine what steps will need to be taken to claim
the funds. The best way for a minor beneficiary to be listed is with a person to act on the minor’s behalf until they reach the
age of majority. We would issue a check while the beneficiary was a minor in good faith to Lucy Brown (or Robert Brown)
for Benefit of Joseph Gregory, a minor. The other way is to establish a trust (see below)
Trust: Linda Johnson Revocable Trust dated 1/13/2004, as amended 1/18/2008.
 The check will always be paid to the Trust, not a Trustee. At the time of a claim a copy of the Trust will be requested listing
the Trustee/Successor Trustee(s) who can sign the paperwork. The Trustee will divide the funds, not us. A Trust usually has
its own Trust Tax Id Number (TIN) in place of a social security number.
Estate: The Trent James Estate.
 At the time of a claim the Certified Letters of Probate will be requested which will list the Court appointed
Executor/Executrix, Administrator, or Personal Representative who can sign. An Estate usually has an Estate Identification
Number (EIN) in place of a social security number.
Partnership: The Llewelyn Limited Partnership.
Business: Chow Hounds Dogfood Incorporated.
Non-Profit Organization or Church: Muscular Dystrophy Association and the First Baptist Church of Lewisville.
 NO 1099’s are ever issued to a non-profit or religious establishment.
Attorney’s Office: Scott, Bane, Smith, & Jenkins LLP.
Collateral Assignment: Please complete a Collateral Assignment Request Form
 If a policy has a Collateral Assignment we will pay the amount listed in the Assignment to the Collateral Assignee with any
remainder to the beneficiary. Assignments are the only forms where dollar amounts that can be accepted. Both would sign
a Claim Form. If the Collateral Assignee has no interest in the funds we must receive a release from them as either a
statement to that effect on their Company Letterhead, or, on most contracts, by the completion of the Release of
Assignment located at the end of the contract. Collateral Assignments are usually Irrevocable, meaning the policyowner
can’t make any changes or surrender or borrow on a policy without the say so of the Collateral Assignee. If there is not
enough money to cover an assignment the entirety is paid to the Assignee.
Funeral Assignment: You may assign all or part of the proceeds to a funeral home. They can either list a specific Funeral Home,
such as the Ruffin and Jarrett Funeral Home, or as Mortuary performing Services. Once a funeral home is listed however if the
family uses Smith Funeral Home instead of Ruffin & Jarrett, we would have to have Ruffin & Jarrett disclaim the proceeds by
sending us a statement on their company letterhead to that effect. A Funeral Home can NOT be a listed beneficiary in the State
of New Jersey.