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How do I fill this out?
To fill out this form, begin by providing the necessary payee information accurately. Next, identify your primary and contingent beneficiaries, including their relationship to you and the percentage of benefits to be allocated. Ensure all required signatures are obtained for a valid submission.

How to fill out the Beneficiary Change Request Form - Protective Life?
1
Complete the payee(s) information section accurately.
2
List primary and contingent beneficiaries with full details.
3
Specify the percentage of benefits to be allocated.
4
Obtain all necessary signatures.
5
Submit the completed form as per the instructions.
Who needs the Beneficiary Change Request Form - Protective Life?
1
Policyholders who wish to update their beneficiary information.
2
Estate planners ensuring the right beneficiaries are assigned.
3
Individuals undergoing life changes like marriage or divorce.
4
Legal representatives managing a deceased person's estate.
5
Financial advisors helping clients manage their insurance policies.
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What are the instructions for submitting this form?
To submit this form, email it to structuredsettlements@protective.com or fax it to (603) 334-5833. You may also send it physically to the address on the form: P.O. Box 13694, Birmingham, AL 35202-3641. Ensure all sections are completed, and signatures are obtained to avoid delays.
What are the important dates for this form in 2024 and 2025?
Ensure you are aware of the deadlines for submitting your beneficiary changes, especially after significant life changes. Keep in mind any policy-specific deadlines that may apply. Staying proactive will help ensure your beneficiaries are properly designated.

What is the purpose of this form?
The purpose of the beneficiary change request form is to allow policyholders to officially designate or update their beneficiaries. This ensures that the policy's benefits are directed according to the policyholder's wishes upon their passing. Accurate completion of this form is essential for effective estate planning and benefit distribution.

Tell me about this form and its components and fields line-by-line.

- 1. Payee Information: Section to enter the names and contact details of the payee.
- 2. Primary Beneficiary Designation: Details of primary beneficiaries designated to receive the policy proceeds.
- 3. Contingent Beneficiary Designation: Information on alternate beneficiaries if primary ones are unavailable.
- 4. Authorization: Signatures required to validate the request.
- 5. Witness: Signature of a disinterested adult witness if applicable.
What happens if I fail to submit this form?
Failing to submit this form can result in outdated beneficiary information. This could lead to unintended distribution of benefits, causing potential disputes among family members. Moreover, ensuring timely updates can prevent confusion in critical moments.
- Outdated Beneficiary Information: Benefits may not go to your intended beneficiaries.
- Legal Disputes: Potential conflicts among surviving family members over benefits.
- Administrative Delays: Delays in processing claims can occur if the form isn't submitted.
How do I know when to use this form?

- 1. Post-Marriage: To update beneficiaries to reflect your new marital status.
- 2. After Divorce: To remove ex-spouses and ensure beneficiaries are current.
- 3. Major Life Events: After any significant events that affect your beneficiaries.
- 4. Estate Planning: To ensure correct designations are in place for your estate.
- 5. Policy Updates: When changing or updating life insurance policies.
Frequently Asked Questions
What is a beneficiary change request form?
This form is used to designate or change beneficiaries for your life insurance policy.
How do I fill this form out?
Provide accurate information, list beneficiaries, and obtain required signatures.
Can I edit this PDF form?
Yes, you can easily edit the PDF using our editing tools.
How do I submit the completed form?
Follow the instructions provided on the form for submission via fax or email.
Is there a deadline for submission?
Ensure submission is timely to reflect any required changes.
What if I make a mistake on the form?
Edit the form as needed before final submission.
Do I need a witness to sign?
Yes, a witness is required in certain jurisdictions.
What is the significance of a contingent beneficiary?
A contingent beneficiary receives benefits if the primary beneficiary passes away.
Can I designate multiple beneficiaries?
Yes, you can designate multiple beneficiaries and specify percentage shares.
What should I do if I have further questions?
Contact customer support for additional assistance.
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