Request for title changes

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Request for title changes"

Transcription

1 1, Complexe Desjardins 95 St. Clair Avenue West ontreal (Quebec) H5B 1E2 Toronto ON 4V 1N7 Request for title changes Please complete this form in BLOCK LETTERS. Instructions Please provide policy number policyowner s name before section A. Please return all pages of this form. In order to: 1. Change the policyowner or add a second policyowner, fill out sections A J follow the instructions for a designation or change of beneficiary. 2. Designate or change the beneficiary for life insurance, fill out sections B J. 3. Designate or change the beneficiary for long term care insurance, fill out sections C J. 4. Designate or change the beneficiary for critical illness insurance health coverage, fill out sections D J. 5. Designate or change the trustee for minor beneficiary, fill out sections E J. 6. Designate or change the contingent policyowner, fill out sections J. 7. Designate or change the contingent beneficiary, fill out sections G J. 8. Change name for individuals legal entities, fill out sections H J. 9. Change the policyowner following the death of the current policyowner, fill out sections I follow the instructions for change of policyowner. Representative Information inancial center no. (internal use) Representative no. (internal use) 09614A (13-05) Use of the masculine gender should be understood to include both men women.

2 Page 2 Important Information CHANGE O POLICYOWNER(S) or a policyowner change, if no beneficiary is designated, the new policyowner s estate will be appointed as beneficiary. If the new policyowner wishes to keep the same beneficiary, the new policyowner must complete the appropriate beneficiary section to designate the beneficiary again. If the current policyowner or the new policyowner is a legal entity (company, business, corporation, cooperative or trust), one of the following guidelines must be applied: enclose a copy of a resolution from the board authorizing the person signing for the legal entity OR a copy of the latest corporate filing documentation with the provincial authorities. Please also complete form 08295E - Required Additional Information on a Corporation or Oganization. If applicable, the additional benefits related to disability, death or loss of job attached to the former policyowner will be cancelled. or an assignment resulting from a divorce or separation, enclose a copy of the decree. AIR ARKET VALUE The term fair market value (V) is defined as the price we can obtain, given general market conditions, during the sale of a property between prudent, informed, unrestricted parties acting at arm s length. NON-AR S LENGTH TRANSACTION As a general rule, for a contract held by an individual, a transfer is considered a non-arm s length transaction when the new policyowner is an ascendant or a descendent of the current policyowner or when he is related by blood, marriage or adoption. or legal entity held contracts, a transfer is considered a non-arm s length transaction when the current policyowner holds a controlling interest in an entity in which he will become the new owner or vice-versa. or a transfer between persons not dealing at arm s-length, the adjusted cost basis (ACB) for income tax purposes equals the policy cash surrender value on the transfer date, irrespective of the consideration paid for the transfer, if any. or an arm s-length transfer, the ACB is adjusted to the consideration paid. If no consideration has been paid for an arm s-length transfer, the ACB is then adjusted to the cash surrender value (deemed to be the fair market value). If you are unsure about the designation (arm s or non-arm s length) of this transfer, you should contact a tax expert because of the serious tax consequences involved. DESIGNATION OR CHANGE O BENEICIARY(IES) or the province of Quebec: the designation of the legally married spouse (married or civil union spouse) as beneficiary is IRREVOCABLE unless stipulated otherwise. The designation of any other person as beneficiary is REVOCABLE unless stipulated otherwise. or rest of Canada (provinces territories): this beneficiary designation is REVOCABLE unless stipulated otherwise. : means that the beneficiary designation can be changed without the beneficiary s consent. : means that the beneficiary designation cannot be changed without the beneficiary s consent. The irrevocable designation of a minor cannot be changed until he reaches the age of majority. All new primary beneficiary designations terminate all previous primary designations, but do not affect any existing contingent beneficiary designations. In cases where a financial institution is designated as beneficiary, indicate the name of the financial institution that it is beneficiary up to the loan balance amount enter the number date of the loan. The amount over above the balance owing is distributed among the other beneficiaries according to their percentage share. If the beneficiary is deceased, the policyowner s estate will be appointed, unless a contingent beneficiary has been designated. The new beneficiary cannot sign as a witness. The beneficiary cannot consent to a change if he is not of the age of majority. If the irrevocable/preferred beneficiary is deceased, enclose an original death certificate. The designation of estate applies to the policyowner s heirs not those of the insured. The percentage allocated to all of the beneficiaries of each insured must add up to 100. DESIGNATION OR CHANGE O A TRUSTEE OR A INOR BENEICIARY or the province of Quebec, in the section irst last name of beneficiary, indicate the name of the trust, for example trust for Julie Smith. IPORTANT NOTICE: for the province of Quebec, this section is intended to inform Desjardins inancial Security Life Assurance Company of the designation or change of trustee, which has to be done either through a fiduciary will or a fiduciary agreement. Consequently, this section cannot be used in Quebec to designate or change a trustee, but is for information purposes only. DESIGNATION OR CHANGE O CONTINGENT POLICYOWNER The contingent policyowner will become the new policyowner of the policy upon the death of the current policyowner. DESIGNATION OR CHANGE O CONTINGENT BENEICIARY If the primary beneficiary should predecease the insured, the contingent beneficiary replaces the primary beneficiary.

3 Page 3 Policy no. irst last name of policyowner 1 irst last name of policyowner 2 A - Change of Policyowner or Addition of Second Policyowner (or addition of second policyowner, list both policyowners.) A1 - New Policyowner(s) - Individual(s) irst name irst name Last name Last name (YYYY//DD) (YYYY//DD) Relationship to insured (matory) Relationship to insured (matory) Social insurance number (if matory) Social insurance number (if matory) Address Address City City Province Postal code Province Postal code Telephone Res. ( ) Bus. ( ) Ext. Cell. ( ) Telephone Res. ( ) Bus. ( ) Ext. Cell. ( ) A2 - New Policyowner(s) - Legal Entity (Complete orm 08295E - Required Additional Information on a Corporation or Organization.) Legal entity name Relationship to insured Entity. Address City Province Postal code Telephone Bus. Ext. A3 - atory Questions (or income tax purposes, please complete the following for a change of policyowner on a contract that provides life insurance coverage.) 1. a) Is the new policyowner the ex-spouse* of the previous policyowner? If YES, is the transfer due to a legal ruling, decision or a written agreement? If there is no legal ruling, decision or written agreement, what is the value of the consideration fair market value (V)**? (You must indicate an amount even if it is zero.) $ b) Is the new policyowner the spouse*, the child* or grchild* of the previous policyowner? c) Is the new policyowner the father, mother, grfather, grmother, brother or sister of the previous policyowner? 2. inancial year end date (/DD). /DD 3. This section must be completed if the change of policyowner involves a legal entity (ex.: a company). a) Is this a non-arm s length transfer*? (See details in section Important Information.) b) If NO, what is the value of the consideration (V)**? (You must indicate an amount even if it is zero.) 4. Is the transfer of the contract made to a creditor for the purpose of securing a debt or a loan (other that a policy loan)? * As defined by the Income Tax Act. ** or the purposes of tax laws, Desjardins inancial Security Life Assurance Company will use the higher of the following amounts: the cash surrender value or the value of the consideration V on the date of receipt of the change request (whichever shown above). *** If YES, for the purposes of tax laws, Desjardins inancial Security Life Assurance Company will use the cash surrender value as of the date the change request is received. $ ***

4 Page 4 B - Designation or Change of Beneficiary(ies) - Life Insurance irst last name irst last name (YYYY//DD) arried Civil union spouse arried Common-law spouse arried Civil union spouse arried Common-law spouse arried Civil union spouse arried Common-law spouse C - Designation or Change of Beneficiary(ies) - Long Term Care Insurance Type of benefit irst last name irst last name (YYYY//DD arried HEALTH BENEIT arried arried DEATH BENEIT (I APPLICABLE) arried arried arried D - Designation or Change of Beneficiary(ies) - Critical Illness Insurance Health Coverages Type of benefit CRITICAL ILLNESS INSURANCE AOUNT irst last name irst last name (YYYY//DD arried arried arried DEATH BENEIT (I APPLICABLE) arried arried arried arried HEALTH BENEIT arried arried

5 Page 5 E - Designation or Change of a Trustee for a inor Beneficiary irst last name of proposed insured irst last name of trustee of trustee (YYYY//DD) Relationship to insured of trustee irst last name of beneficiary 1 irst last name of beneficiary 2 irst last name of beneficiary 3 - Designation or Change of Contingent Policyowner (Tax impact will be considered at time of event.) irst last name of contingent policyowner Relationship to policyowner (YYYY//DD) Address City Province Postal code Telephone Res. Cell. Bus. Ext. G - Designation or Change of Contingent Beneficiary(ies) irst last name irst last name (YYYY//DD) arried arried arried H - Change of Name for Individuals Legal Entities (Include document, if applicable.) I, the undersigned policyowner, ask that: be replaced by ollowing: a legal adoption (enclosed document) a legal name change (enclosed document) an error made in the application (YYYY//DD) other (specify): I - Change of Policyowner ollowing the Death of the Policyowner I, the undersigned, having reached the age of majority, declare that (all persons concerned must sign this statement): 1) The policyowner of the policy mentioned above,, died on (YYYY//DD) as evidenced by the death certificate submitted to Desjardins inancial Security Life Assurance Company. 2) The policy mentioned above is included in the deceased s estate. 3A) All provinces territories except Quebec - This declaration is made pursuant to: the certificate of appointment of estate trustee / notarial copy of letters probate 3B) Province of Quebec only - This declaration is made pursuant to: the attached will the attached marriage contract the legislative provisions (if no testamentary provisions exist, attach relevant documents) other (specify): Pursuant to the document mentioned above, the said contract is bequeathed to: irst last name (YYYY//DD) irst last name (YYYY//DD) Continue Section I on page 6

6 Page 6 I - Change of Policyowner ollowing the Death of the Policyowner (cont.) Continuation of 3B WAIVER O HEIRS - ANY HEIR WHO WISHES TO WAIVE HIS RIGHTS UNDER THIS POLICY UST COPLETE THE SECTION BELOW. Acknowledging that, henceforth, they will no longer have any interest in the said policy, the undersigned waive all their rights, claims, privileges obligations related to this policy in favour of: Name of new policyowner(s) Signature of heir waiving his rights (Quebec only) Name of heir waiving his rights (BLOCK LETTERS) Signature of heir waiving his rights (Quebec only) Name of heir waiving his rights (BLOCK LETTERS) Signature of witness Name of witness (BLOCK LETTERS) J - Statements Signatures Date (YYYY//DD) OR A POLICYOWNER CHANGE, STATEENTS 1 AND 2 APPLY. OR A BENEICIARY CHANGE, STATEENT 3 APPLIES. 1- DECLARATION O CURRENT POLICYOWNER(S): I, the undersigned, hereby revoke the current revocable beneficiary(ies) waive all my rights, titles obligations under the contract. I also request, if applicable, the cancellation of any waiver of premium benefit on my life assign my contract in favour of the policyowner(s) designated in section A. 2- DECLARATION O NEW POLICYOWNER(S): I, the undersigned, hereby consent to becoming policyowner of this contract with all the associated rights, titles, privileges obligations. 3- DECLARATION O REVOKED BENEICIARY(IES): I, the undersigned, hereby consent to the revocation of my designation as irrevocable/preferred beneficiary of the insurance. Signature of current policyowner 1 (individual) Signature of new policyowner 1 (individual) Signature of current policyowner 2 (individual) Signature of new policyowner 2 (individual) Signature of the person authorized to sign for the current policyowner (legal entity) Signature of the person authorized to sign for the new policyowner (legal entity) Signature of irrevocable/preferred beneficiary Name title (BLOCK LETTERS) of the person authorized to sign for the current policyowner (legal entity) Name title (BLOCK LETTERS) of the person authorized to sign for the new policyowner (legal entity) Name of irrevocable/preferred beneficiary (BLOCK LETTERS) Signature of consent of assignee Name of consent of assignee (BLOCK LETTERS) Signature of executor (if applicable) Name of executor (if applicable) (BLOCK LETTERS) Signature of witness Name of witness (BLOCK LETTERS) K - Registration by Desjardins inancial Security Life Assurance Company Date (YYYY//DD) Desjardins inancial Security Life Assurance Company has registered this change, but assumes no responsability for the validity or legality of the document. Registered by Date (YYYY//DD)

INDIVIDUAL LIFE INSURANCE

INDIVIDUAL LIFE INSURANCE POLICIES AND PROCEDURES GUIDE INDIVIDUAL LIFE INSURANCE REQUIRED SIGNATURES... 5 TRANSACTION FEES... 7 CLIENT TITLE CHANGES (Non-Financial)... 8 Address... 8 Assignment for Collateral... 9 Beneficiary...

More information

Change of Beneficiary and/or Rightsholder (Owner) (Page 1 of 5) Form No. 10481 (11/2006)

Change of Beneficiary and/or Rightsholder (Owner) (Page 1 of 5) Form No. 10481 (11/2006) MONY Life Insurance Company P.O. Box 4830 Syracuse, New York 13221 INSTRUCTIONS FOR COMPLETING THIS FORM Section 1. Designation of Beneficiary and Method of Payment Payment will be made in one sum. Settlement

More information

MACHINISTS LODGE 692 HEALTH AND BENEFIT PLAN

MACHINISTS LODGE 692 HEALTH AND BENEFIT PLAN MACHINISTS LODGE 692 HEALTH AND BENEFIT PLAN REVISED CARD CHECK HERE h APPLICATION FOR ENROLMENT AND BENEFICIARY DESIGNATION Please complete in ink and print clearly. This is a two-sided form please see

More information

UNITED HERITAGE CREDIT UNION DEFINED BENEFIT PLAN INSTRUCTIONS FOR DESIGNATING OR CHANGING BENEFICIARY

UNITED HERITAGE CREDIT UNION DEFINED BENEFIT PLAN INSTRUCTIONS FOR DESIGNATING OR CHANGING BENEFICIARY Beneficiary Form Instructions INSTRUCTIONS FOR DESIGNATING OR CHANGING BENEFICIARY These instructions will assist you in properly completing the DESIGNATION OF BENEFICIARY form. 1. To designate one person,

More information

Application for Fixed and Life Annuity For registered and non registered contract

Application for Fixed and Life Annuity For registered and non registered contract POU Client Services Tel. 506-853-6040/1-888-577-7337 Fax 506-853-9369/1-855-577-3864 financial.services@assumption.ca Application for Fixed and Life Annuity For registered and non registered contract 1.

More information

INSTRUCTIONS FOR COMPLETING THIS FORM

INSTRUCTIONS FOR COMPLETING THIS FORM Phone 800-9593894 P.O. Box 4763 Syracuse, New York 13221-4763 INSTRUCTIONS FOR COMPLETING THIS FORM (Page 1 of 5) Sections 1 & 2. Designation of Beneficiary Complete the beneficiary designation (FIRST,SECOND).

More information

GGAI TAX-FREE SAVINGS ACCOUNT

GGAI TAX-FREE SAVINGS ACCOUNT Global Growth Assets Inc. (GGAI) GGAI TAX-FREE SAVINGS ACCOUNT application form www.globalgrowth.ca GGAI TAX-FREE SAVINGS ACCOUNT APPLICATION FORM 1. MANAGER GLOBAL PROSPERATA FUNDS INC. Account Number

More information

Important Information About Changing The Beneficiary On An Insurance Policy

Important Information About Changing The Beneficiary On An Insurance Policy Commonly Asked Questions IMPORTANT NOTICE Throughout your life you are likely to experience changes such as birth, adoption and marriage that may result in you wanting to re-examine your choice of beneficiary.

More information

TRANSFERRING Inventory of assets. The importance of informing others of your intentions

TRANSFERRING Inventory of assets. The importance of informing others of your intentions TRANSFERRING Inventory of assets The importance of informing others of your intentions This tool will help you pass on important information about yourself to the people you re close to. The information

More information

Managing a Portfolio of Life Insurance Policies

Managing a Portfolio of Life Insurance Policies Managing a Portfolio of Life Insurance Policies 2010 CIFPs National Conference June 14, 2010 James W. Kraft CA, MTax, CFP, TEP, CLU Important considerations This material is for information purposes only

More information

Tax-Free Savings Account

Tax-Free Savings Account Tax-Free Savings Account Office Use Only Plan ID Advisor (Last KYC Review Date) Account Holder Information First Name Last Name Address (P.O. Box and General Delivery not acceptable) City Province Postal

More information

Mr. Mrs. Ms. Miss Dr. (circle one)

Mr. Mrs. Ms. Miss Dr. (circle one) I.A. Michael Investment Counsel Ltd. Tax-Free Savings Account Application Account Holder Information Mr. Mrs. Ms. Miss Dr. (circle one) Last Name, First Name and Initial Account Number / New Account Date

More information

To simplify matters for my loved ones in the event I become incapacitated or die, I am preparing an inventory of my assets and important documents.

To simplify matters for my loved ones in the event I become incapacitated or die, I am preparing an inventory of my assets and important documents. Personal Record of My Assets and Important Documents Personal Inventory of My Assets and Important Documents To simplify matters for my loved ones in the event I become incapacitated or die, I am preparing

More information

A p p l i c a t i o n f o r a S i n g l e P r e m i u m Pa y o u t A n n u i t y Po l i cy

A p p l i c a t i o n f o r a S i n g l e P r e m i u m Pa y o u t A n n u i t y Po l i cy A p p l i c a t i o n f o r a S i n g l e P r e m i u m Pa y o u t A n n u i t y Po l i cy Registered and Non-Registered In this application, the terms you and your mean the owner of The Canada Life Payout

More information

Tax implications when transferring ownership of a life insurance policy

Tax implications when transferring ownership of a life insurance policy Tax implications when transferring ownership of a life insurance policy May 2015 Jean Turcotte, B.A.A., LL.B., CLU Director, Tax, Wealth & Insurance Planning Group Sun Life Financial FOR ADVISOR USE ONLY

More information

INSTRUCTIONS FOR BENEFICIARY DESIGNATION FORMS. Congress passed the Retirement Equity Act in 1984, and as a result,

INSTRUCTIONS FOR BENEFICIARY DESIGNATION FORMS. Congress passed the Retirement Equity Act in 1984, and as a result, INSTRUCTIONS FOR BENEFICIARY DESIGNATION FORMS TO: FROM: Congress passed the Retirement Equity Act in 1984, and as a result, - If you are married, your plan benefits are automatically paid to your spouse

More information

TAX, RETIREMENT & ESTATE PLANNING SERVICES. An advisor s guide to insurance trusts

TAX, RETIREMENT & ESTATE PLANNING SERVICES. An advisor s guide to insurance trusts TAX, RETIREMENT & ESTATE PLANNING SERVICES An advisor s guide to insurance trusts Insurance Trust AN EFFECTIVE TOOL IN PLANNING YOUR CLIENT S ESTATE An insurance trust can be an effective tool to help

More information

Private Capital Solutions. Tax-Free Savings Accounts (TFSA) Registered Retirement Savings Plans (RRSP)

Private Capital Solutions. Tax-Free Savings Accounts (TFSA) Registered Retirement Savings Plans (RRSP) Private Capital Solutions Tax-Free Savings Accounts (TFSA) Registered Retirement Savings Plans (RRSP) Computershare Forms Guide On the following pages you will find these applications forms. Tax-Free Savings

More information

G You are totally and permanently disabled. If you have checked this box, complete Sections III, IV and V of this application.

G You are totally and permanently disabled. If you have checked this box, complete Sections III, IV and V of this application. THE NATIONAL ASBESTOS WORKERS SUPPLEMENTAL PENSION PLAN BENEFIT APPLICATION For Distributions Over $5,000 INSTRUCTIONS: Please read this application carefully and completely before answering any questions.

More information

Personal inventory of assets and important documents

Personal inventory of assets and important documents savings and Guaranteed Investment Funds Protecting your estate Personal inventory of assets and important documents To simplify matters for members of a family, in the event one of them becomes incapacitated

More information

Instructions For Choosing Your Beneficiary

Instructions For Choosing Your Beneficiary Prudential 30 Scranton Office Park Scranton, PA 18507-1789 Please print using blue or black ink. Keep a copy for your records and send the original form to the address above or fax it to 1-866- 439-8602.

More information

INVESTMENT APPLICATION

INVESTMENT APPLICATION VERSION DATE: JUNE 2011 INVESTMENT APPLICATION SINGLE PREMIUM IMMEDIATE ANNUITY Policy Number ANY AMOUNT THAT IS ALLOCATED TO A SEGREGATED FUND IS INVESTED AT THE RISK OF THE OWNER AND MAY INCREASE OR

More information

SELF-DIRECTED RETIREMENT SAVINGS PLAN APPLICATION

SELF-DIRECTED RETIREMENT SAVINGS PLAN APPLICATION SELF-DIRECTED RETIREMENT SAVINGS PLAN APPLICATION CALEDON TRUST COMPANY LIRA Locked in Retirement Account* LRSP Locked in Retirement Savings Plan* RSP - Retirement Savings Plan - Member Plan RSP - Retirement

More information

United of Omaha Life Insurance Company A Mutual of Omaha Company

United of Omaha Life Insurance Company A Mutual of Omaha Company United of Omaha Life Insurance Company A Mutual of Omaha Company Change of Ownership/Beneficiary Forms Packet Contains Life Insurance Change of Ownership Form Life Insurance Application for Change of Beneficiary

More information

DESIGNATION OF BENEFICIARY For:

DESIGNATION OF BENEFICIARY For: 730 Third Avenue New York NY 10017-3206 DESIGNATION OF BENEFICIARY For: Group Supplemental Retirement Annuities Rollover Individual Retirement Annuities Supplemental Retirement Annuities Classic Individual

More information

INSTRUCTIONS FOR COMPLETING THE FOLLOWING FORMS:

INSTRUCTIONS FOR COMPLETING THE FOLLOWING FORMS: INSTRUCTIONS FOR COMPLETING THE FOLLOWING FORMS: BENEFICIARY DESIGNATION FORM: Every Plan Participant must complete a Beneficiary Designation form. This designation does not apply to any insurance policy(ies)

More information

New York Life Insurance Company

New York Life Insurance Company New York Life Insurance Company A Mutual Company Founded in 1845 51 Madison Avenue, New York, NY 10010 GROUP DECREASING BASIC TERM LIFE INSURANCE AND LEVEL BASIC TERM LIFE INSURANCE CERTIFICATE ("CERTIFICATE")

More information

DESIGNATION OF BENEFICIARY For:

DESIGNATION OF BENEFICIARY For: DESIGNATION OF BENEFICIARY For: Group Supplemental Retirement Annuities Rollover Individual Retirement Annuities Supplemental Retirement Annuities Classic Individual Retirement Annuities Group Retirement

More information

Transfer of ownership and appointment of contingent owner

Transfer of ownership and appointment of contingent owner Transfer of ownership and appointment of contingent owner The following administrative guidelines explain the procedures to transfer ownership rights and/or to appoint a Contingent Owner under the following

More information

PERSONAL INVENTORY OF ASSETS. For an easier transfer of your wealth

PERSONAL INVENTORY OF ASSETS. For an easier transfer of your wealth PERSONAL INVENTORY OF ASSETS For an easier transfer of your wealth PERSONAL INVENTORY OF ASSETS Are you planning your estate? Would you like to give your loved ones everything they need to manage your

More information

Beneficiary Designations for Life Insurance: Estate Planning

Beneficiary Designations for Life Insurance: Estate Planning Vertex Wealth Management, LLC Michael J. Aluotto, CRPC President Private Wealth Manager 1325 Franklin Ave., Ste. 335 Garden City, NY 11530 516-294-8200 mjaluotto@1stallied.com Beneficiary Designations

More information

Administration guide

Administration guide Administration guide for Sun Life Financial-administered group plans Use this guide if Sun Life Financial administers your plan members records and prepares your billing statements. Our guides are stored

More information

LIFE INSURANCE ENDORSEMENT METHOD SPLIT DOLLAR PLAN AGREEMENT

LIFE INSURANCE ENDORSEMENT METHOD SPLIT DOLLAR PLAN AGREEMENT Exhibit 10.21 LIFE INSURANCE ENDORSEMENT METHOD SPLIT DOLLAR PLAN AGREEMENT Insurer/Policy Number: Bank: New York Life Insurance Company Heritage Bank Of Commerce Insured: Relationship of Insured to Bank:

More information

NOTICE OF QUALIFIED PRE-RETIREMENT SURVIVOR ANNUITY (QPSA)

NOTICE OF QUALIFIED PRE-RETIREMENT SURVIVOR ANNUITY (QPSA) NOTICE OF QUALIFIED PRE-RETIREMENT SURVIVOR ANNUITY (QPSA) Participant Name: Employer: New Form Date Completed: Age: QPSA Waived Replacement Form Date Completed: Age: QPSA Waived FOR DEFINED BENEFIT PLANS

More information

EASY INSTRUCTIONS FOR CONTRACT CHANGE OR OWNERSHIP AUTHORIZATION REQUEST

EASY INSTRUCTIONS FOR CONTRACT CHANGE OR OWNERSHIP AUTHORIZATION REQUEST EASY INSTRUCTIONS FOR CONTRACT CHANGE OR OWNERSHIP AUTHORIZATION REQUEST Requesting changes to or designating ownership authorization for a contract requires the contract owner's signature. 1. Print, complete,

More information

The Beneficiaries, Total Premium and Premium Payment Frequency shown are as of the Policy Summary date at the top of this page.

The Beneficiaries, Total Premium and Premium Payment Frequency shown are as of the Policy Summary date at the top of this page. Policy Summary This Policy Summary is dated When your insurance contract renews or if you make a change to your insurance contract that affects the Total Premium, we will send you a new Policy Summary.

More information

DESIGNATION OF BENEFICIARY For:

DESIGNATION OF BENEFICIARY For: P.O. Box 1268 Charlotte NC 28201-1268 DESIGNATION OF BENEFICIARY For: Group Supplemental Retirement Annuities Rollover Individual Retirement Annuities Supplemental Retirement Annuities Classic Individual

More information

Tax Free Savings Account Application

Tax Free Savings Account Application Tax Free Savings Account Application THIS APPLICATION FORM CAN BE USED FOR: TFSA (TAX FREE SAVINGS ACCOUNT) Section 1: Plan Type Value Partners Investments Inc. - Tax Free Savings Account Application 400-305

More information

Terms & Conditions of Janney Montgomery Scott LLC Transfer on Death ( TOD ) Account Registration

Terms & Conditions of Janney Montgomery Scott LLC Transfer on Death ( TOD ) Account Registration Terms & Conditions of Janney Montgomery Scott LLC Transfer on Death ( TOD ) Account Registration Instructions: Carefully read the Terms & Conditions below and complete all applicable sections of the attached

More information

INSURANCE BENEFICIARY CHANGES

INSURANCE BENEFICIARY CHANGES LEGISLATIVE GENERAL COUNSEL 6 Approved for Filing: E. Chelsea-McCarty 6 6 01-14-13 12:28 PM 6 H.B. 65 1 INSURANCE BENEFICIARY CHANGES 2 2013 GENERAL SESSION 3 STATE OF UTAH 4 Chief Sponsor: Jim Bird 5

More information

Transfer on death (TOD) beneficiary designation

Transfer on death (TOD) beneficiary designation Introduction Transfer on death (TOD) beneficiary designation Instructions Use this form for non-retirement John Hancock mutual fund accounts. This form allows you to establish a designation will apply

More information

New York Life Insurance Company

New York Life Insurance Company New York Life Insurance Company A Mutual Company Founded in 1845 51 Madison Avenue, New York, NY 10010 GROUP LEVEL TERM LIFE AND DEPENDENT LIFE INSURANCE TO AGE 80 WITH CONTRIBUTIONS EXPECTED, BUT NOT

More information

Non-registered plan, RSP, RIF, LIRA (QC), LIF, Annuity, Deferred Life Annuity, Deferred Life Annuity-LIRA (QC) Application/Instructions Form

Non-registered plan, RSP, RIF, LIRA (QC), LIF, Annuity, Deferred Life Annuity, Deferred Life Annuity-LIRA (QC) Application/Instructions Form Application/Instructions Form T097 (12-2015) Non-registered plan, RSP, RIF, LIRA (QC), LIF, Annuity, Deferred Life Annuity, Deferred Life Annuity-LIRA (QC) Application/Instructions Form Non-registered

More information

Self-Directed Retirement Savings Plan Application

Self-Directed Retirement Savings Plan Application Self-Directed Retirement Savings Plan Application Annuitant Information Last Name, First Name and Initial Mr. Mrs. Ms. Miss Dr. (circle one) Street Address Apt. Date of Birth (mm/dd/yyyy) City Province

More information

THE EMPIRE LIFE INSURANCE COMPANY TRILOGY. Policy Summary

THE EMPIRE LIFE INSURANCE COMPANY TRILOGY. Policy Summary Policy Summary This Policy Summary is dated June 1, 2012. When you make a change to your Contract, we will issue a new version of these pages. The Policy Summary with the most recent date replaces any

More information

LOCAL 282 - WELFARE, PENSION, ANNUITY & JOB TRAINING TRUST FUNDS

LOCAL 282 - WELFARE, PENSION, ANNUITY & JOB TRAINING TRUST FUNDS Participant's Name Participant's Address Social Security No. Telephone # BENEFICIARY DESIGNATION PART I. COMPLETE PART I. IF YOU ARE MARRIED I am married to Full Name of Spouse My spouse's date of birth

More information

EMPIRE LIFE GUARANTEED INVESTMENT FUNDS 75/100 APPLICATION FOR A NOMINEE/INTERMEDIARY ACCOUNT

EMPIRE LIFE GUARANTEED INVESTMENT FUNDS 75/100 APPLICATION FOR A NOMINEE/INTERMEDIARY ACCOUNT VERSION DATE: NOVEMBER 2014 EMPIRE LIFE GUARANTEED INVESTMENT FUNDS 75/100 APPLICATION FOR A NOMINEE/INTERMEDIARY ACCOUNT Upon receiving confirmation of your contract purchase please record your contract

More information

Beneficiary is: " " Beneficiary is: " "

Beneficiary is:   Beneficiary is:  DOC010538120 Service address: RiverSource Life Insurance Co. of New York 70500 Ameriprise Financial Center Minneapolis, MN 55474 Life Insurance and Annuity Change of Beneficiary i New York Insurance Regulation

More information

Part-time Employee Retirement Plan Designation of Beneficiary

Part-time Employee Retirement Plan Designation of Beneficiary Part-time Employee Retirement Plan Designation of Human Resources To the Trustee (s) or Custodian (as applicable) of the Austin Community College Money Purchase Plan Printed Name of Participant I hereby

More information

CIBC Guaranteed Acceptance Life Insurance Policy

CIBC Guaranteed Acceptance Life Insurance Policy CIBC Guaranteed Acceptance Life Insurance Policy 30-DAY REVIEW PERIOD As the Owner You can cancel this Policy at any time by contacting us at the number below or writing to the address below. If You cancel

More information

Funeral Aid Insurance: Application for benefit

Funeral Aid Insurance: Application for benefit Funeral Aid Insurance: Application for benefit Employee Benefits Name of scheme Code Important: This form must be completed when: the insurance of an employee commences in terms of the policy or there

More information

EASY INSTRUCTIONS FOR CHANGING THE BENEFICIARY DESIGNATION

EASY INSTRUCTIONS FOR CHANGING THE BENEFICIARY DESIGNATION EASY INSTRUCTIONS FOR CHANGING THE BENEFICIARY DESIGNATION I. Print, complete and return the beneficiary designation fm with the required signature(s) to change the beneficiary on your contract. (Please

More information

CONVERSION OF GROUP OR EMPLOYEE LIFE INSURANCE TO AN INDIVIDUAL POLICY

CONVERSION OF GROUP OR EMPLOYEE LIFE INSURANCE TO AN INDIVIDUAL POLICY CONVERSION OF GROUP OR EMPLOYEE LIFE INSURANCE TO AN INDIVIDUAL POLICY Life Insurance Company of North America Group Insurance Life Accident Disability What is the conversion privilege? The right of an

More information

WHY YOU NEED A WILL - QUEBEC

WHY YOU NEED A WILL - QUEBEC WHY YOU NEED A WILL - QUEBEC REFERENCE GUIDE Where there s a Will, there s a way. Better still, when there s a Will, it s your way. Having a Will drafted and executed is the best way to ensure that your

More information

BENEFIT DISTRIBUTION REQUEST FORM (For Distributions due to Termination, Death, Disability, and Retirement) Date: EIN: 16-6184130 TIN: 611256314

BENEFIT DISTRIBUTION REQUEST FORM (For Distributions due to Termination, Death, Disability, and Retirement) Date: EIN: 16-6184130 TIN: 611256314 BENEFIT DISTRIBUTION REQUEST FORM (For Distributions due to Termination, Death, Disability, and Retirement) : EIN: 16-6184130 TIN: 611256314 Plan Name: UFCW LOCAL ONE 401(K) SAVINGS PLAN Participant Data

More information

LIFE INSURANCE CLAIM

LIFE INSURANCE CLAIM LIFE INSURANCE CLAIM Life Insurance Claim - Instructions 1. For a Life Insurance Claim: The beneficiary (claimant) should complete the Beneficiary s (claimant s) Statement and submit the completed claim

More information

Office of the Fiduciary Supervisor Kanawha County Commission P.O. Box 3627, Charleston, WV 25336 (304) 357-0125

Office of the Fiduciary Supervisor Kanawha County Commission P.O. Box 3627, Charleston, WV 25336 (304) 357-0125 Office of the Fiduciary Supervisor Kanawha County Commission P.O. Box 3627, Charleston, WV 25336 (304) 357-0125 Step 3: The Short Form Settlement Dear Personal Representative, Date: RE: Estate of: The

More information

This Trust is made the... day of... in the year... (the Trust )

This Trust is made the... day of... in the year... (the Trust ) Part A - Date of Trust If you are applying for a new policy and wish it to be issued in trust please tick this box and leave the date below blank. The trust will become effective on the same date as the

More information

Disclosure Statement for Life Settlement Contracts

Disclosure Statement for Life Settlement Contracts Life Settlement Financial, LLC P.O. Box 3437 San Rafael, CA 94912-3437 Tel: (415) 526-5970 Fax: (415) 526-5971 inquiries@lifesettlementfinancial.com Disclosure Statement for Life Settlement Contracts Read

More information

MAKING A WILL. This guide will give you some information about Wills and help you do your own basic, simple Will.

MAKING A WILL. This guide will give you some information about Wills and help you do your own basic, simple Will. MAKING A WILL This guide will give you some information about Wills and help you do your own basic, simple Will. This is not to be construed as legal advice. WHAT IS A WILL? A Will is a document that you

More information

Arizona Life Settlement Qualification Form

Arizona Life Settlement Qualification Form PERSONAL INFORMATION Arizona Life Settlement Qualification Form First Insured Name: SS # Current Address: City: State: Zip: Date of Birth: Driver s License Number: State: Expiration: Second Insured Name:

More information

Pre-Retirement Beneficiary Designation Form

Pre-Retirement Beneficiary Designation Form Pre-Retirement Beneficiary Designation Form INSTRUCTIONS You are eligible under your Plan to have a death benefit paid to a beneficiary if you die before you begin receiving retirement benefits. Your death

More information

Living Trust Overview

Living Trust Overview Living Trust Overview TABLE OF CONTENTS WHAT IS PROBATE AND WHY DO YOU WANT TO AVOID IT? 2 THE HIGH COST OF DYING 2 A REVOCABLE LIVING TRUST ELIMINATES PROBATE 3 HOW A LIVING TRUST WORKS 3 REVOCABLE LIVING

More information

New York Life Insurance Company

New York Life Insurance Company New York Life Insurance Company A Mutual Company Founded in 1845 51 Madison Avenue, New York, NY 10010 GROUP DECREASING TERM LIFE & DEPENDENT LIFE INSURANCE TO AGE 70 CERTIFICATE ( CERTIFICATE ) POLICYHOLDER

More information

Application/Instructions Form. TFSA Savings Annuity T087 (06-2015)

Application/Instructions Form. TFSA Savings Annuity T087 (06-2015) Application/Instructions Form TFSA Savings Annuity T087 (06-2015) Application/Instructions Form TFSA Savings Annuity New client? Yes If so, complete the Contractholder s Identification section No If not,

More information

New York Life Insurance Company

New York Life Insurance Company New York Life Insurance Company A Mutual Company Founded in 1845 51 Madison Avenue, New York, NY 10010 GROUP ANNUAL RENEWABLE TERM LIFE & DEPENDENT LIFE INSURANCE TO AGE 100 CERTIFICATE (CERTIFICATE) POLICYHOLDER

More information

Single Premium Immediate Annuity (SPIA) Application

Single Premium Immediate Annuity (SPIA) Application Single Premium Immediate Annuity (SPIA) Application Cheques must be made payable to Transamerica Life Canada Highlighted sections must be completed to avoid delay Not available for corporate ownership

More information

New York Life Insurance Company

New York Life Insurance Company New York Life Insurance Company A Mutual Company Founded in 1845 51 Madison Avenue, New York, NY 10010 GROUP DECREASING TERM LIFE & DEPENDENT LIFE INSURANCE TO AGE 70 WITH AN ACCELERATED DEATH BENEFIT

More information

Life Insurance Benefits

Life Insurance Benefits Understanding Your Life Insurance Benefits Table of Contents Welcome 1 Eligibility 2 Insurance Types 2 Employee Life Insurance 3 Basic Life Insurance 3 Optional Life Insurance 3 Insurance Benefits - Basic

More information

LAST WILL AND TESTAMENT

LAST WILL AND TESTAMENT LAST WILL AND TESTAMENT WHAT IS A WILL? A will is a legal document prepared during your lifetime to take effect upon your death. IT ALLOWS YOU TO: decide what to do with your Estate rather than have the

More information

Pension death benefits discretionary trust.

Pension death benefits discretionary trust. retirement annuity contract Pension death benefits discretionary trust. IMPORTANT NOTES before completing this Trust, please read the following notes. 1. This documentation has been produced for consideration

More information

DURABLE POWER OF ATTORNEY

DURABLE POWER OF ATTORNEY This document was prepared by: John Doe 100 Main Street Miami, Florida 33109 Return To: John Doe 100 Main Street Miami, Florida 33109 DURABLE POWER OF ATTORNEY OF John Doe I. PRINCIPAL AND ATTORNEY-IN-FACT

More information

Title 18-A: PROBATE CODE

Title 18-A: PROBATE CODE Title 18-A: PROBATE CODE Article 6: NONPROBATE TRANSFERS Table of Contents Part 1. MULTIPLE-PARTY ACCOUNTS... 3 Section 6-101. DEFINITIONS... 3 Section 6-102. OWNERSHIP AS BETWEEN PARTIES, AND OTHERS;

More information

Creditor Protection and Life Insurance

Creditor Protection and Life Insurance Creditor Protection and Life Insurance Introduction As a general rule, all assets of an individual or entity are security for unpaid debts owing to a creditor. This applies whether or not the individual

More information

WILLS, POWERS OF ATTORNEY, AND HEALTH CARE DIRECTIVES

WILLS, POWERS OF ATTORNEY, AND HEALTH CARE DIRECTIVES WILLS, POWERS OF ATTORNEY, AND HEALTH CARE DIRECTIVES Glossary Administrator Alternate Bequest Capable Codicil Consent Devise Estate Executor A person appointed by the courts to distribute the property

More information

Changing A Beneficiary Designation

Changing A Beneficiary Designation Changing A Beneficiary Designation The following pages contain information to assist you in recording the beneficiary for your term life policy. Making sure that your benefits will be distributed in strict

More information

Beneficiary Designation

Beneficiary Designation Beneficiary Designation Defined Benefit Plan For active or deferred members of the Alaska Public Employees Retirement System (PERS) and Teachers Retirement System (TRS) Defined Benefit Plan Welcome to

More information

If you are 55 years or older and are retiring or separating from the County of San Diego, your

If you are 55 years or older and are retiring or separating from the County of San Diego, your UTerminal Pay Plan Frequently Asked Questions If you are 55 years or older and are retiring or separating from the County of San Diego, your accrued sick and vacation leave will be paid out through the

More information

ESTATE PLANNING QUESTIONNAIRE

ESTATE PLANNING QUESTIONNAIRE DATE: _ ESTATE PLANNING QUESTIONNAIRE I. FAMILY AND OCCUPATIONAL DATA: Name: Date of Birth: Address: Citizenship: SS#: Telephone # Home: Work: Cell: Email: Occupation: Name of Employer: Business Address:

More information

Insurance Trusts. Richard Niedermayer. 2012 Atlantic Provinces Tax Conference

Insurance Trusts. Richard Niedermayer. 2012 Atlantic Provinces Tax Conference Insurance Trusts Richard Niedermayer 2 Insurance Trusts A. The Strategy A form of testamentary trust funded with the proceeds of an insurance policy (or policies) payable on death of the testator For personal

More information

Request to Change Beneficiary on Life Insurance Policies

Request to Change Beneficiary on Life Insurance Policies Request to Change Beneficiary on Life Insurance Policies The Prudential Insurance Company of America Pruco Life Insurance Company of New Jersey Pruco Life Insurance Company All are Prudential Financial

More information

GROUP BENEFITS A LEGACY OF CARING. Employee s Guide to Group Life Beneficiary Designations and Assignments

GROUP BENEFITS A LEGACY OF CARING. Employee s Guide to Group Life Beneficiary Designations and Assignments GROUP BENEFITS A LEGACY OF CARING. Employee s Guide to Group Life Beneficiary Designations and Assignments AN EMPLOYEE GUIDE TO DESIGNATING BENEFICIARIES. The importance of designating and maintaining

More information

DESIGNATION OF TRANSFER ON DEATH (TOD) BENEFICIARY AGREEMENT

DESIGNATION OF TRANSFER ON DEATH (TOD) BENEFICIARY AGREEMENT Please complete this form to establish a Transfer on Death (TOD) beneficiary on your account. If you have questions about this form, call 800-245-7311, or consult your legal advisor. A TOD direction transfers

More information

QUESTIONS AND ANSWERS ABOUT NEW HAMPSHIRE WILLS, TRUSTS & PROBATE

QUESTIONS AND ANSWERS ABOUT NEW HAMPSHIRE WILLS, TRUSTS & PROBATE QUESTIONS AND ANSWERS ABOUT NEW HAMPSHIRE WILLS, TRUSTS & PROBATE Prepared by: Warren F. Lake Attorney at Law P.O. Box 123 3 Tower Hill Road Sanbornton, NH 03269 603-286-2287 WILLS What is a will? A person's

More information

New York Life Insurance Company

New York Life Insurance Company New York Life Insurance Company A Mutual Company Founded in 1845 51 Madison Avenue, New York, NY 10010 GROUP ANNUAL RENEWABLE TERM LIFE & DEPENDENT LIFE INSURANCE TO AGE 100 CERTIFICATE (CERTIFICATE) POLICYHOLDER

More information

Life Insurance o $300,000 in death benefits o $100,000 in cash surrender or withdrawal values

Life Insurance o $300,000 in death benefits o $100,000 in cash surrender or withdrawal values NOTICE OF PROTECTION PROVIDED BY ALASKA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION This notice provides a brief summary of the Alaska Life and Health Insurance Guaranty Association (Association) and

More information

ESTATE PLANNING OUTLINE

ESTATE PLANNING OUTLINE ESTATE PLANNING OUTLINE By LEONARD S. ROTH Attorney and Counselor at Law The Law Offices of Leonard S. Roth, P.C. 4265 San Felipe, Fifth Floor Houston, Texas 77027 (713) 622-4222 Board Certified in Tax

More information

Policy Owner Service Request Form Instructions

Policy Owner Service Request Form Instructions Policy Owner Service Request Form Instructions This form has 12 parts, to handle a variety of changes. Please read all bolded titles and complete the appropriate section. For all changes, the top portion

More information

insurance company policy number issue date (00/00/0000) face amount total policy loan cash surrender value amount paid

insurance company policy number issue date (00/00/0000) face amount total policy loan cash surrender value amount paid LIFE SETTLEMENT QUESTIONNAIRE (please print clearly) Life Insurance Policy Information policy number issue date (00/00/0000) face amount total policy loan cash surrender value annual premium payment next

More information

ALABAMA POWER OF ATTORNEY FORM (in accordance to Alabama Code Section 26-1A-301)

ALABAMA POWER OF ATTORNEY FORM (in accordance to Alabama Code Section 26-1A-301) ALABAMA POWER OF ATTORNEY FORM (in accordance to Alabama Code Section 26-1A-301) IMPORTANT INFORMATION This power of attorney authorizes another person (your agent) to make decisions concerning your property

More information

Copy of the Life Insured s/payor s (for Payor Benefit)/ Child (For Serious Illness of a Child Benefit)) Identity Card/Birth Certificate/ Passport

Copy of the Life Insured s/payor s (for Payor Benefit)/ Child (For Serious Illness of a Child Benefit)) Identity Card/Birth Certificate/ Passport Dear Claimant We are sorry to learn of your illness/ injury. In order for us to process the claim, we require the following: 1. Critical Illness Form 2. Attending Physician s Statement 3. Copy of the Life

More information

Group Benefits Life Conversion Option

Group Benefits Life Conversion Option Group Benefits Life Conversion Option Facts about converting your Group Life coverage to an individual policy As a Manulife group plan member, you may be eligible to convert your group life insurance to

More information

FLORIDA WILL INSTRUCTIONS All Property to Trust Pour Over Will U.S. Legal Forms, Inc.

FLORIDA WILL INSTRUCTIONS All Property to Trust Pour Over Will U.S. Legal Forms, Inc. FLORIDA WILL INSTRUCTIONS All Property to Trust Pour Over Will U.S. Legal Forms, Inc. http://www.uslegalforms.com This form is for person(s) who are establishing or have established a Living Trust. Although

More information

Death Benefit Distribution Claim Form Non-Spousal Beneficiary

Death Benefit Distribution Claim Form Non-Spousal Beneficiary Death Benefit Distribution Claim Form Non-Spousal Beneficiary READ THE ATTACHED IRS SPECIAL TAX NOTICE: IF THE PLAN ALLOWS FOR AN ANNUITY OPTION, READ THE WRITTEN EXPLANATION OF QUALIFIED JOINT AND 50%

More information

California Life Settlement Qualification Form

California Life Settlement Qualification Form PERSONAL INFORMATION California Life Settlement Qualification Form First Insured Name: SS # Current Address: City: State: Zip: Date of Birth: Driver s License Number: State: Expiration: Second Insured

More information