Change of Beneficiary

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Change of Beneficiary

Date:

RE: Insurance Policy Number:

Insured:

Owner:

Dear Sir or Madam:

I am writing to instruct you to make the following change(s) to the above policy. I would like to change a primary beneficiary.

The new primary beneficiary should be: ___________________.

Please send me a confirmation letter and, if necessary, a form to make this change.

Thank you for your assistance.

Best regards,

_____________

Insurance Policy Owner