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Beneficiary Change: 1. General Information

This document is a beneficiary change form. It revokes any previous beneficiary designations and directs life insurance or pension/education plan proceeds to be paid to the new primary beneficiaries listed. The primary beneficiaries, their citizenship, relationship to the insured/payor, birthdate, and age are provided. It notes that proceeds will be paid equally among surviving beneficiaries unless the policy states otherwise. The form requires signatures of the life insured, plan owner, and agent/witness.

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Andy De Guzman
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79 views1 page

Beneficiary Change: 1. General Information

This document is a beneficiary change form. It revokes any previous beneficiary designations and directs life insurance or pension/education plan proceeds to be paid to the new primary beneficiaries listed. The primary beneficiaries, their citizenship, relationship to the insured/payor, birthdate, and age are provided. It notes that proceeds will be paid equally among surviving beneficiaries unless the policy states otherwise. The form requires signatures of the life insured, plan owner, and agent/witness.

Uploaded by

Andy De Guzman
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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BENEFICIARY CHANGE

Name of Life Insured (Last, First, MI)


1. General Information
Name of Policy Owner, if different from Life Insured, (Last, First, MI) Policy Number/s

Telephone No. Mobile No. Email Address

2. Details of change Life Insurance Pension/Education Insurance riders attached attached to plan

The undersigned hereby revokes any beneficiary designation or direction of payment previously made in respect to the proceeds payable to on the death
of the Life Insured/Planholder under the above policy/ies and directs such proceeds to be paid for.

Primary beneficiary/ies

Full Name Citizenship Relationship to Insured/Payor Birthday Age Primary Contingent Irrevocable Revocable

Designation
Trustee if any beneficiary is under age 18 Relationship of Trustee to Minor Beneficiary

Address of beneficiaries

Note:
For IRREVOCABLE BENEFICIARY/IES designation, please submit a completely filled-out Irrevocable Form together with this form.
Changes after the policy is placed in force require the signature of IRREVOCABLE BENEFICIARY/IES, photocopy/ies of valid ID and must be witnessed by
the Insurance Advisor.

Important:
Proceeds are payable equally among all surviving revocable beneficiaries appointed, if more than one named, or all to the only survivor, unless the
policyplan provides differently.

Date signed Place signed Name and signature of Life Insured


3. Signatures
Name and signature of Plan Owner Name and signature of irrevocable beneficiary

Name and signature of Agent/Witness Agent’s Code

The Manufacturers Life Insurance Co. (Phils.) Inc.


LKG Tower, 6801 Ayala Avenue, Makati City 1226 Philippines
Tel. No.: (63-2) 88-4-LIFE (884-5433) • Customer Care: (63-2) 884-7000 • 1-800-1-888-6268 (Toll Free) • Fax: (63-2) 844-2558 • Email: [email protected] ManulifePH

A Manulife Financial Company, Corporate Headquarters in Toronto, Canada. www.mymanulife.com.ph www.manulife.com.ph


Manulife and the block design are registered service marks and trademarks of the Manufacturers Life Insurance Company
and are used by it and its affiliate including Manulife Financial Corporation.
CS-MP001-2015

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