TemplatesOwl
Homepage ↦ Fill Out Your Mony Change Beneficiary Form
Article Structure

The Mony Change Beneficiary form serves a crucial role in managing beneficiary designations and ownership rights for policyholders of MONY Life Insurance. This form allows an individual to update or change who will receive the insurance benefits upon the insured's death. Its first section primarily focuses on designating beneficiaries and specifying payment methods, where it is essential to provide the full legal names and relationships of all beneficiaries, ensuring clarity and legality. Furthermore, this section includes a space for supplemental information to be documented. In addition to updating beneficiary information, the form facilitates changes in the rightsholder or owner of the policy, allowing for a seamless transfer of ownership rights. Each section presents clear instructions to ensure accurate completion, including guidelines for necessary signatures depending on the owner’s status—individual, corporation, partnership, or trust. The form accommodates joint beneficiaries and group designations, ensuring that all wishes are reflected appropriately. Various legal stipulations underline the importance of adhering to correct naming conventions and compliance with tax and ownership guidelines, making it essential for policyholders to carefully review this document before submission.

Mony Change Beneficiary Example

 MONY Life Insurance

 MONY Life Insurance

Express Mail:

Change of Beneficiary and/or

Company

Company of America

100 Madison St

Rightsholder (Owner)

P.O. Box 4830

P.O. Box 4720

Syracuse, NY 13202

(Page 1 of 6)

Syracuse, New York 13221

Syracuse, New York 13221

 

 

 

 

Form No. 10481 (10/2010)

INSTRUCTIONS FOR COMPLETING THIS FORM

Section 1. Designation of Beneficiary and Method of Payment

Payment will be made in one sum. Settlement Option is not available unless elected on Beneficiary, Rights and Settlement Option Request (Form 4113).

Complete the beneficiary designation (FIRST, SECOND), using the sample wordings on Page 2 as a guide for completing your designation. It is not necessary to designate a SECOND beneficiary, but the space is provided if you choose to do so. The relationship of the proposed beneficiary(ies), to the Insured person must be stated in Section 1.

Use the full legal name — Linda Smith, not Mrs. John Smith.

Current law requires us to request the name and address of each beneficiary (including the current list of living members in a group designation like “my children”) as well as the Relationship of each beneficiary named to the Insured. After completing the beneficiary designation in Section 1, you should provide this supplemental information below the name of each beneficiary noted on Page 4 in the space provided.

If you have named a person as beneficiary, the FINAL beneficiary will be the insured’s executors or administrators unless otherwise indicated. Is this your intent? Keep the rightsholder (owner) in mind. For example, if rights are vested in the Insured or the final rights revert to the Insured, the FINAL beneficiary is generally the executors or administrators of the Insured’s Estate. If, however, final rights are to be vested in someone other than the Insured (such as a spouse), the FINAL beneficiary is generally the executors or administrators of that person (surviving beneficiary).

Section 2. Designation of Rightsholder (Owner)

First Review Your Beneficiary Designation. Do you want to complete Section 1 in addition to Section 2?

To change the rightsholder (owner) on your policy, check the appropriate box. If rights are to be transferred to someone other than the Insured, complete 2. A and B. (See sample wordings on Page 2.)

Section 3. Signatures

To sign on behalf of a corporation:

1.An officer other than the Insured and other than the secretary must sign and the signing officer must specify his/her corporate title.

2.If the only two officers in the corporation are the Insured and the secretary, please submit a statement to that effect or indicate that fact in Section 3. See below for additional signature requirements:

Professional Corporation (“PC”)

Officer or Shareholder. Prefer someone who is both.

Registered Limited Liability

 

Partnership (“R.L.L.P.”)

Partner

Limited Liability Company (“L.L.C.”)

Member or Manager. Any other person would have to approve his/her

 

authority under its opening agreement of Articles of Organization.

Professional Service L.L.C. (“P.S.L.L.C.”)

Same as L.L.C.

3.State the complete legal name of the Corporation as it appears in your Charter or Certificate of Incorporation. DO NOT use the corporate assumed name alone (its d/b/a).

4.The final beneficiary and/or rightsholder (owner) will be the Corporation’s successors or assigns.

To sign for a partnership:

1. A general partner other than the insured must sign in the following manner: (state full name of the partnership)

by:

 

. A limited partner may not sign for a partnership.

 

(member of the firm)

2.The final beneficiary and/or rightsholder (owner) will be the Partnership’s successors or assigns. To sign on behalf of a tax-qualified plan:

1.The qualified trustee(s) must sign in the capacity of “trustee”, of the qualified/tax-sheltered plan, not individually.

2.State the full name of the tax-qualified plan as it appears in the plan.

GENERAL

A proposed Beneficiary Must Sign if designated to receive “as interest may appear” or in any way indicating the rightsholder’s (owner’s) indebtedness to the beneficiary, when that rightsholder is retaining any rights which would enable him at any time to eliminate the interest of the proposed beneficiary.

IMPORTANT: PLEASE READ THIS SPECIAL INSTRUCTION SHEET BEFORE COMPLETING THE FORM.

E14751

(Page 2 of 6)

SAMPLE WORDINGS

If you need help in wording a designation or if your designation is too long for this form, send us details of the change desired and we will prepare the form for you based on our interpretation of the information, it will then be subject to your approval.

SAMPLE WORDINGS FOR COMPLETING FIRST AND SECOND BENEFICIARY DESIGNATIONS IN SECTION 1.

If you wish to designate . . .

Please use this language . . .

SINGLE BENEFICIARY

 

a person

— Spouse, Jane Doe

Insured’s estate

— Insured’s executors or administrators

corporation

— XYZ Corporation, or its successors or assigns.

partnership

— Smith and Jones, a partnership, or its successors or assigns.

GROUP (more than one person) BENEFICIARY

 

children

— children, John Doe, Susan Doe and Frank Doe (will not include any other children)

 

— children of Insured including John Doe, Susan Doe and Frank Doe

 

— children of marriage of Insured and spouse, Mary Doe

 

— children of marriage of Insured and spouse, Mary Doe, including John

 

Doe and Susan Doe

parents

— Father, James Doe and mother, Frances Doe

named brothers and sister

— Sister, Jane Doe, and brothers John Doe, Frank Doe.

(nieces and nephews, aunts and uncles, etc.)

 

TRUST BENEFICIARY

 

Trustee under written trust (living trust)

— John Jones (XYZ Bank) as trustee or his (its) successor trustee under an Agreement

Provide the names of Trustee(s), the name of

dated May 1, 1978 made by and between the Insured and said trustee.

living trust, date of living trust, the name(s) of

 

grantor(s). If all identifying trust information is

 

not provided, a Statement as to Trustee/

 

Beneficiary Form 3559 will be required.

 

Testamentary Trust (Trust created in a Will) The terms of trust must be fully contained in the Will and the Will must be probated to effectuate the trust.

—the trustee or successor trustee under a trust created under the Instrument probated as the Last Will and Testament of the Insured or, if the Insured shall die intestate or shall leave a will not creating a trust, the

Insured’s executors or administrators.

NOTE: If your Will specifies that some portion (or all) of your estate must be distributed (“poured over”) to a trust that is already in existance, (a living trust), then you can designate the trustee under the written trust agreement as the beneficiary, you need not designate the executor or a trustee under a testamentary trust.

SAMPLE WORDINGS FOR COMPLETING RIGHTSHOLDER (OWNER) DESIGNATIONS

IN SECTION 2.A and 2.B, IF APPLICABLE.

If you wish to designate . . .

Please use this language . . .

SINGLE RIGHTSHOLDER

 

a person

— Jane Doe, spouse

corporation

— XYZ Corporation, or its successors or assigns.

partnership

— Smith and Jones, a partnership, or its successors or assigns.

 

TRUST RIGHTSHOLDER

 

Usually no other rightsholder, and no FINAL

— John Jones (or XYZ Bank) as trustee or his (its) successor trustee under an Agreement

rightsholder, needs to be named after this (an

dated May 1, 1978 made by and between the Insured and said trustee.

irrevocable trust) designation; but, if there is a

 

need to do so, (a revocable trust) complete the

 

FINAL rights (Section 2B) or send us full details

 

and we will propose a designation for you.

 

GROUP (more than one person) RIGHTSHOLDER

Group rightsholders must act jointly and ownership interests cannot be apportioned.

children

— Insured’s children

 

— children, Jane Doe, John Doe and Mary Doe

 

— children of marriage of Insured and spouse, Mary Doe

 

— children of marriage of Insured and spouse, Mary Doe, including John

 

Doe and Susan Doe

parents

— Mother, Jane Doe and Father, James Doe -OR-

 

Mother and Father of Insured, Jane and James Doe, respectively.

E14751

Continued Next Page

(Page 3 of 6)

SAMPLE WORDINGS CONTINUED ..........

SINGLE PRIMARY RIGHTSHOLDER AND SINGLE CONTINGENT RIGHTSHOLDER

spouse, followed by child

— Spouse, Mary Doe, if living, if not, daughter, Jane Doe

SINGLE PRIMARY RIGHTSHOLDER AND GROUP CONTINGENT RIGHTSHOLDER

spouse, followed by unnamed children

— Spouse, Mary Doe, if living, if not, Insured’s children

spouse, followed by named children

— Spouse, Harry Doe, if living, if not, son, Frank Doe and daughter, Jane Doe

GROUP PRIMARY RIGHTSHOLDERS AND SINGLE CONTINGENT RIGHTSHOLDER

children, followed by spouse

— Insured’s children, if none is living, spouse, Mary Doe

General Information for Change in Ownership

•If the new Owner is a U.S. citizen, they must have a primary residence in the United States. If the person is a U.S.

Citizen but lives abroad, the change of ownership will require the approval of the AXA Equitable Anti-Money Laundering Office (AMLO).

•If the new Owner is not a U.S. citizen, they must have a primary resident address in the U.S. and have an unexpired visa or Green Card. Copies of the unexpired visa or Green Card must be submitted with this request. We will accept an unexpired visa in the following visa categories: A, E, G, H, I, K, L, N, NATO, P, R, S, T, TN, TD, U TPS or V. We will also need a copy of an unexpired visa and I-94 document.

•A Non-U.S. citizen that has a visitor’s visa, an expired Green Card or visa, no visa or has a visa in the following categories: B, C, D, F, J, M, Q, TWOV, will not be accepted as a new Owner and the ownership change must be declined under the AXA Financial Anti-Money Laundering policy.

•For Legal Resident Aliens: A copy of the unexpired Green Card or acceptable visa and I-94 form will be required to be submitted with the change of ownership request.

•For Trusts: Taxpayer Identification Number of the Trust and a copy of a Trust certification or significant pages and signature page of the Trust Agreement that proves the existence of the Trust, the name and date of the Trust Agreement,

as well as the name of the Trustee(s).

•For Partnerships: Pertinent page from the Partnership agreement that proves the Partnership exists and indicates the names of the Partners.

•For Private Corporations: Articles of Incorporation or copy of business license and documentation indicating the acting party has the authority to act on behalf of the Corporation.

•For Publicly Traded Corporations: No additional requirements need to be submitted.

•All non-resident individual and foreign business (Corporation, Trust, Partnership) new Owners require the approval of the AXA Equitable AMLO. In addition to the requirements outlined above, the AMLO also requires these new Owners to have a U.S. Bank account.

General Information for New Owner(s) concerning Taxpayer Identification Number

•Federal Law requires you to provide to us the correct Taxpayer Identification Number which matches your name.

•If you fail to provide the correct Taxpayer Identification Number, tax withholding may be required and penalties may apply.

•Your Taxpayer Identification Number is your Social Security Number if you are an individual and a U.S. person. A

U.S. person is a U.S. citizen, or a non-citizen of the United States who is a U.S. resident for tax purposes. If you are a foreign individual who is not eligible to apply for a Social Security Number, your Taxpayer Identification Number is your Individual Taxpayer Identification Number or “ITIN” issued by the IRS. If you are an entity (U.S. or foreign), your Taxpayer Identification Number is the Employer Identification Number or “EIN” issued by the IRS.

•In the case of a minor, the minor.s Social Security Number must be provided. If the minor does not have a Social

Security Number, the natural guardian for the minor owner may obtain one by applying to the Social Security Administration on Application Form SS-4. If the newly acquired number is not received by AXA Equitable/AXA Life and Annuity/MONY Life Insurance Company of America within 60 days, AXA Equitable/AXA Life and Annuity/MONY Life Insurance Company of America is required by law to withhold on any taxable interest being credited to the policy/ contract.

E14751

(Page 4 of 6)

General Information on USA PATRIOT Act – Customer Identification Program

•Section 326 of the USA PATRIOT Act outlines important information about procedures for opening new accounts

•To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

•To comply with Section 326, AXA Equitable/AXA Life and Annuity/MONY Life Insurance Company of America will ask for your name, address, date of birth, and other information necessary to allow us to identify you when opening an account. We may also ask to see your driver.s license or other identifying documents.

You May Use This Form:

To change either the beneficiary or the rightsholder (or both).

For any number of policies, provided you are requesting an identical change for each policy.

To change the beneficiary for proceeds payable at the Insured’s death only for Family Plan policies issued prior to 1968. The beneficiary of the proceeds payable upon the death of the insured wife and insured children will remain as stated in the policy or previous family plan endorsement.

You may NOT use this form:

To change the beneficiary on any MONY Employee or FU Pension or Benefit Plans, Disability Insurance Policies. Send us details of changes required for such policies and we’ll prepare a request for the rightsholder’s signature.

For settlement options on non - qualified policies. Use BENEFICIARY, RIGHTS and SETTLEMENT OPTION REQUEST (Form 4113), which may be obtained from your MONY Field Underwriter. (Settlement Options are not available on qualified policies.)

-OR-

To release an assignment. Assignment of Policy/Release of Assignment (Form 3600) is required and may be obtained from your MONY Field Underwriter.

TAX CONSEQUENCES

An attorney should be consulted about possible tax consequences in the following instances:

(a)if the rightsholder is not the Insured and is not the beneficiary; (b) if the rightsholder designates joint rights to two or more individuals, as a gift; (c) if the rightsholder is a corporation and is not a beneficiary; (d) if rights are changed on an annuity issued after April 22, 1987; (e) a transfer to a person two or more generations younger than the transferor (generation skipping); (f) if the policy has a loan and the rights are being transferred as a gift.

INFORMATION ON DIVORCE

If you are required to designate an ex-spouse or children as beneficiary(ies) pursuant to a divorce decree or order, then the decree should be submitted to us. We will try to conform the beneficiary designation to the terms of the decree. An endorsement will be sent to you and will be deemed to be accepted by you unless you notify us of your rejection. If you currently have your ex-spouse listed as beneficiary, then you should either change the beneficiary to reflect your new choice of beneficiary or to reconfirm your desire to designate the ex-spouse despite the divorce. In most states, a divorce does not automatically extinquish the rights of an ex-spouse as beneficiary. Therefore an Insured who inadvertently leaves his/her ex-spouse as beneficiary after a divorce may cause payment of the death benefits to the ex-spouse even though such payment is contrary to his/her intent. If your ex-spouse

is the beneficiary and you do not want him/her to be a beneficiary, then you should submit a change of beneficiary request.

E14751

MONY Life Insurance

MONY Life Insurance

Express Mail:

CHANGE FORM

 

Company

Company of America

100 Madison St

(RIGHTS, BENEFICIARY,

P.O. Box 4830

P.O. Box 4720

Syracuse, NY 13202

METHOD OF PAYMENT)

Syracuse, NY 13221

Syracuse, NY 13221

 

(Page 5 of 6)

 

(Not licensed in WY and NY)

 

 

 

Form No. 10481 (Rev. 10/2010)

 

 

 

Agency

Code

Policy Numbers

Insured’s Name (as it appears on policy)

If Insured’s name has changed, state new name and reason for change :

If more space is required, please print “See Attached”. The form and attachment(s) must include the policy number(s), have the same date, and be signed by the owner. Joint beneficiaries will receive equal shares proportionate to the number of those beneficiaries who survive the Insured. Proceeds will be payable in one sum.

1. PRIMARY

Are any named beneficiaries a Viatical or Life Settlement Company?

 

Yes

No

 

 

 

 

 

BENEFICIARY(IES)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

if living, if not

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Relationship(s)

 

 

(Names of First Beneficiary(ies)

 

 

 

 

 

(Date(s) of Birth)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please type or print full

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

name and indicate the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

relationship to the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

insured person

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Beneficiary(ies) Address:

 

 

 

 

 

 

 

 

Beneficiary(ies) Social Security # :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTINGENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BENEFICIARY(IES)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Relationship(s)

 

 

(Names of First Beneficiary(ies)

 

 

 

 

 

(Date(s) of Birth)

 

 

 

 

 

if living, if not

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please type or print full

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone number:

 

 

 

 

 

 

 

 

 

 

 

name and indicate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

relationship to the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Beneficiary(ies) Address:

 

 

 

 

 

 

 

 

Beneficiary(ies) Social Security # :

 

 

 

 

 

insured person.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FINAL

If no beneficiary named above is living at the Insured’s death, the beneficiary is the Insured’s executors or administrators,

BENEFICIARY

unless checked:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The executors or administrators of the survivor of all beneficiaries (the last designated beneficiary to die)

To be completed for

Is this ownership change in connection with a viatical or life settlement transaction?

 

 

Yes

No

change of Rights

Is the new owner a US citizen or a legal entity established under US law?

 

 

 

 

 

Yes

No

(owner)

If the new owner is a nominee, fiduciary or intermediary for a beneficial owner,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. RIGHTS

is the beneficial owner a US citizen or a legal entity established under US law?

 

 

 

 

 

Yes

No

Rightsholder,

Please change the Policy(ies) so that all rights provided in “Rights (Ownership) Under Policy” (refer to #5 on Page 6)

Contract

belong exclusively to (if naming joint rightsholders, the following information needs to be provided for all named rightsholders):

holder (Owner) on

 

 

a.

Insured/Annuitant

Individual

Trust

 

Partnership

Corporation Other

record remains

 

 

 

Full Name of Proposed Rightsholder(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

unchanged Unless

 

 

 

Relationship to Insured/Annuitant

 

 

 

 

 

 

 

 

 

 

 

Date of Birth

 

 

 

 

 

 

 

 

this section is

 

 

 

Legal Residence (Full Street, City, State, Zip)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

completed.

 

 

 

Mailing Address (if different from Legal Address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Where two or more

 

 

 

Phone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

New Rightsholder Occupation and Type of Business

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rightsholders are

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Soc Sec #/TIN (IRS Form W-9 signed by new rightsholder must be included)

 

 

 

 

 

 

Designated, those

 

 

 

 

 

 

 

 

 

 

 

 

All non-resident individual and foreign business new rightsholders must have a US Bank

Living shall act jointly

 

 

 

 

 

 

Account: Name of Bank

 

 

 

 

 

 

 

 

 

 

 

Account Number

 

 

 

 

 

 

 

 

 

 

Unless otherwise

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b.

FINAL RIGHTSHOLDER (IF ALL PERSONS DESIGNATED IN a. PREDECEASE THE INSURED):

indicated.

 

 

 

 

 

The Insured / Annuitant - Final Rightsholder will be the Insured if no box is checked.

 

 

 

 

 

 

 

 

 

 

The executors and administrators of the rightsholder, if two or more rightsholders, the

 

 

 

 

 

executors or administrators of the survivor of said rightsholders (the last to die).

IRS Form W-9 must be

 

IF AN

 

The contractholder’s spouse. Only check this box if contract is an Annuity (see note).

ANNUITY

 

NOTE ON ANNUITIES: If the contract has a Contingent Annuitant Provision, and if the primary Annuitant

Completed by the

 

 

 

 

is the Contractholder at the time of death, the Successor Contractholder must be designated as the

NEW RIGHTSHOLDER

 

 

 

Primary Contractholder’s Spouse for the Contingent Annuitant Provision to continue the contract. At the

and Submitted to the

 

 

 

death of the Primary Contractholder, the contract MUST be surrendered and the proceeds paid out if the

Company with new

 

 

 

Contractholder’s Spouse DOES NOT then become the Contractholder.

 

 

 

 

 

 

 

 

 

 

 

 

 

c.

If the policy(ies) provide for an endowment or life income at annuity commencement. The right to receive

Rightsholder’s TIN

 

 

 

 

 

such endowment or life income at annuity commencement belongs exclusively to the Insured/Annuitant.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.SIGNATURES The undersigned Rightsholder (Owner) requests the Company to accept and record the designations above, to add the provisions on

page 6 of this form his/her/its policy/contract (if necessary to update it), to issue an endorsement consistent with the above designations or to accept

this form as an endorsement (whichever it deems appropriate), and to accept any material changes above that I have initialed or otherwise ratified. If

signing on behalf of a corporation or partnership, see “Instructions” Page 1, Section 3 - “Signatures”.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

 

 

Witness

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

of Owner FIRST NAME

INITIAL

LAST NAME

 

 

If Rightsholder (Owner) resides in Massachusetts, a Witness is mandatory

 

 

 

 

 

 

 

 

and a named beneficiary may not be a witness.

 

 

 

 

 

 

 

 

 

 

 

Additional

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature FIRST NAME

INITIAL

LAST NAME

 

Rightsholder’s (Owner) Daytime Phone Number

 

 

 

 

 

FOR HOME OFFICE USE: Form Recorded and Endorsement Waived:

 

Date

 

 

 

 

By

 

 

 

 

 

MONY Life Insurance Company

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For Agency Use Only:

Pending Transaction: contact

Policyowner

FU

Agency F.U. Full Address if not at Agency of Record

 

 

Completed Transaction: contact

Policyowner

FU

Agency

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print F.U. or ASA Name

E14751

GENERAL PROVISIONS

(Page 6 of 6)

1.DEFINITIONS

(a)“WE”, “US”, “OUR” and “Company” refer to The MONY Life Insurance Company or any of its insurance subsidiaries.

(b)“insured wife” and “insured child” —For family plan policies, wherever these words appear in this form, the section of the Policy entitled “definition of insured wife and insured child” will also apply to any endorsement.

3. TRUST PROVISIONS IN LIVING TRUSTS AND WILLS

A written trust or will cannot change the terms of your policy or otherwise bind the Company. Further, the Company cannot determine at any time whether a trust or will is valid. Accordingly, the Company cannot assume any responsibility for the trustee’s performance or failure to perform any trust duties and the Company will not have any further obligations under a policy if it has made a payment to (or honored a specific request by) a trustee.

(c)HOME OFFICE. Our Operations Center in Syracuse, New York and our World Headquarters in New York, New York are included within the meaning of Home Office.

(d)RELATIONSHIPS. All relationships used in the beneficiary and rights designations refer to the Insured unless otherwise indicated.

(e)“Policy”, “Insured” and “Policyholder”. For annuities, wherever these words appear in this form, they mean “Contract”, “Annuitant” and “Contractholder”, respectively. For Group Universal Life, whenever Policy and Policyholder appear in

this form they mean Certificate and Certificateholder, respectively.

(f)RIGHTSHOLDER (OWNER) A person who can exercise rights is a rightsholder. In contrast, a person designated as contingent rightsholder can only act upon the death of the primary rightsholder and is not considered a rightsholder until the happening of that event. Wherever “Rightsholder” appears on this form, it means “Rightsholder”, “Owner” and “Policyholder”.

2.DETERMINATION OF BENEFICIARY. The beneficiary in Section 1 will become entitled to the amount payable (proceeds) in the order and proportion stated. For proceeds payable at the Insured’s death:

Payment made in one sum: Unless otherwise stated, a beneficiary will not be considered “living” unless the beneficiary is living on the earlier of (a) the day due proof of the Insured’s death is received by us at our Home Office and (b) the 14th day after the Insured’s death. The share of the death proceeds of any beneficiary who is not living on the earlier of these two dates will be payable to the remaining beneficiaries in the manner provided.

4. POLICY ASSIGNMENT

The interest of any beneficiary or other person will be subordinate to any assignment whenever made. We may rely solely on the assignee’s statement as to the amount of its interest in the death benefit proceeds, which will be payable in one sum.

5. RIGHTS (OWNERSHIP) UNDER POLICY

Subject to the rights of any assignee, during the Insured’s lifetime and prior to the date of any endowment proceeds or life income at maturity becoming payable, the right to change the beneficiary, the right to assign, the right to receive any endowment proceeds or life income at maturity or to change the payee thereof, and all other rights, benefits, options, and privileges conferred by the Policy or allowed by the Company belong exclusively as designated in the application for this Policy unless otherwise provided by endorsement or as designated in Section 2 on Page 5.

6. CHANGES IN BENEFICIARY AND RIGHTSHOLDER (OWNER)

These changes may be made during the Insured’s lifetime by written request to us at our Home Office. The Policy need not be presented for endorsement unless requested by us. Any such change will take effect as of the date the notice was signed, upon acceptance and recording at the Home Office, subject to any payment made by us or action taken by us before receipt of the request at our Home Office.

7.SETTLEMENT OPTIONS

Use BENEFICIARY, RIGHTS AND SETTLEMENT

OPTION REQUEST (Form 4113) which may be obtained from your MONY Field Underwriter. (Settlement Options are not available for Qualified policies).

FOR HOME OFFICE USE ONLY

Endorsement No.

 

 

 

Endorsement to Agency

DO NOT DESTROY

 

 

 

 

 

 

 

 

PD 99

10481

 

 

Endorsement sent to

File with App #

 

 

10660

12388

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PI 10

 

 

 

Policy/Statement Returned

Servicer’s Name

 

 

 

 

 

 

 

 

 

 

 

11330 LA

12491

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11197 LA

BART

 

Agy

 

 

FU #

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E14751

Get Mony Change Beneficiary PDF Form

Form Characteristics

Fact Name Fact Description
Beneficiary Designation Required Each beneficiary's full legal name and relationship to the insured must be provided on the form.
Single or Multiple Beneficiaries It is possible to designate either a single beneficiary or multiple beneficiaries, and equal shares will be distributed among those named.
State-Specific Requirements In Massachusetts, a witness is mandatory, and a named beneficiary cannot serve as a witness.
Final Beneficiary Clause If no living beneficiaries are named at the insured's death, the executors or administrators of the insured’s estate will become the final beneficiary.
Ownership Requirements All owners must be U.S. citizens or legal entities established under U.S. law to change ownership of the policy.

Guidelines on Utilizing Mony Change Beneficiary

You're about to change or update your beneficiary details using the Mony Change Beneficiary form. Completing this form accurately is important to ensure your wishes are honored and the intended beneficiaries receive the benefits. This step-by-step guide will help you navigate through the form with ease.

  1. Start by filling in the Agency Code and Policy Numbers at the top of the form.
  2. Enter the Insured’s Name exactly as it appears on the policy.
  3. If there has been a name change for the Insured, provide the new name and the reason for the change.
  4. Section 1: For Primary Beneficiary, list their full name, date of birth, address, relationship to the insured, and Social Security number.
  5. If applicable, designate a Contingent Beneficiary. Follow the same guidelines as for the Primary Beneficiary.
  6. Decide if the Final Beneficiary is to be the Insured’s executors or administrators and check the appropriate box if needed.
  7. Section 2: Indicate the rightsholder (owner). If necessary, check the appropriate box to indicate whether it's the Insured, individual, trust, partnership, corporation, or another entity.
  8. Fill in the details for the proposed rightsholder(s) including their full name, relationship to the insured, date of birth, legal residence, and Social Security number or Tax Identification Number.
  9. If the owner is a trust, ensure that the Taxpayer Identification Number of the Trust is included along with relevant trust certification documents.
  10. In Section 3, sign and date the form as the rightsholder (owner). Include a witness signature if applicable.
  11. If you have a labeled witness (in case of Massachusetts laws), ensure that the witness doesn’t have the same last name as any beneficiary listed.
  12. Provide a daytime phone number for additional contact.
  13. Finally, review the entire form to ensure accuracy before submitting it to the company.

Once you’ve submitted the form, it will be reviewed by the Mony team. If all details are correct, they will process your request and update their records accordingly. Expect confirmation that your changes have been implemented. Keeping your beneficiary information current is crucial, so make it a habit to review this information periodically.

What You Should Know About This Form

What is the purpose of the Mony Change Beneficiary form?

The Mony Change Beneficiary form is designed for individuals looking to update or change the beneficiaries or rightsholders on their life insurance policies issued by MONY Life Insurance Company. This form allows policyholders to specify who will receive the policy benefits in the event of their death, ensuring that loved ones or designated parties are recognized accordingly. Completing this form accurately is essential to ensure that the intended beneficiaries receive the benefits without potential delays or complications.

How should I fill out the beneficiary designation section?

When filling out the beneficiary designation section, you need to clearly list the full legal names of the beneficiaries. For instance, use “Linda Smith” instead of “Mrs. John Smith.” It’s also important to identify the relationship of each beneficiary to the insured. You have the option to designate both primary and contingent beneficiaries, though only naming a primary beneficiary is necessary. If you choose to name multiple beneficiaries, you should be aware that they will share the proceeds proportionally according to the number of beneficiaries alive at the time of the insured's death.

What happens if I don't update my beneficiaries after a divorce?

If you have gone through a divorce and do not update your beneficiary designations, your ex-spouse may still be entitled to benefits under your policy. In many states, a divorce does not automatically revoke an ex-spouse's status as a beneficiary. Therefore, if you want to ensure that your current preferences are honored, it’s important to officially change your beneficiaries after a divorce, especially if mandated by a divorce decree. Failing to do so could lead to unwanted outcomes regarding the distribution of benefits.

Can I change the owner of my policy using this form?

Yes, the Mony Change Beneficiary form also allows you to change the rightsholder or owner of your policy. If you wish to transfer ownership, ensure you check the appropriate box and complete the necessary sections detailing the new owner. It's essential that the new rightsholder is either a U.S. citizen or a qualified entity under U.S. law. Be prepared to provide supporting documentation as required for various ownership categories, such as partnerships, corporations, or trusts.

Common mistakes

Filling out the Mony Change Beneficiary form can be a straightforward process. However, several common mistakes can complicate matters and hinder the effective execution of this important document. Understanding these pitfalls can encourage more accurate submissions.

One prevalent mistake involves the incomplete or incorrect designation of beneficiaries. Many individuals neglect to use the full legal names of the beneficiaries. Instead of writing "Mrs. John Smith," it is essential to note "Linda Smith." This omission may create issues during the disbursement of benefits. Furthermore, individuals frequently skip providing the necessary relationship information between themselves and the beneficiaries, which is required by current law.

Additionally, many people overlook the need for a secondary beneficiary. While the Mony Change Beneficiary form allows for a secondary designation, neglecting this option can lead to confusion in the event that the primary beneficiary is no longer living. Not providing a secondary beneficiary could ultimately slow down the claims process and leave loved ones without essential funds at a critical time.

Another common error involves the failure to update the beneficiary designations after significant life events. Events like marriage, divorce, or the birth of children can significantly change one's intentions regarding beneficiary designations. If these designations remain unchanged, the final distribution of assets may contradict the individual’s current wishes, which can lead to unintended and often distressing outcomes.

People also often neglect to inform beneficiaries of their designation. Without this communication, beneficiaries may remain unaware of their status, leading to potential disputes or even legal issues. It is prudent to discuss these matters openly with intended beneficiaries to avoid any surprises in the future.

Furthermore, individuals may incorrectly fill out the Taxpayer Identification Number section. If a correct and matching Taxpayer Identification Number is not provided, the form could incur tax withholding penalties, complicating the financial situation for both parties. Ensuring the accuracy of this information is crucial.

Not reading the instruction sheet thoroughly also contributes to errors. Many users of the form skip this step entirely, potentially missing critical instructions that could simplify the process. A close review of guidelines can illuminate necessary details that may help avoid confusion down the line.

Lastly, improperly signing the document poses a significant risk. For those attempting to sign on behalf of a corporation or partnership, it is vital to ensure that the signer's authority is clearly established. If the signature fails to comply with the specified instructions, it may result in the denial of the beneficiary change request.

In conclusion, awareness of these common mistakes is key to successfully filling out the Mony Change Beneficiary form. A careful and informed approach can help ensure that beneficiaries are designated according to one's true desires, ultimately reducing the likelihood of disputes and delays in the future.

Documents used along the form

When completing a Mony Change Beneficiary form, there are several other documents and forms that may often accompany it. These documents serve various purposes, from providing additional details about the beneficiary or ownership structure to ensuring compliance with legal requirements. Below are some common forms that may be used alongside the Mony Change Beneficiary form.

  • Beneficiary, Rights and Settlement Option Request (Form 4113): This form is used to elect payment options for the beneficiaries designated in the Mony Change Beneficiary form. If there is a need for a settlement option, the details can be specified here.
  • Assignment of Policy/Release of Assignment (Form 3600): If a policy is being assigned to a different party, this form serves to formally assign the rights to the beneficiary, transferring the ownership as specified in the Mony Change Beneficiary form.
  • Statement as to Trustee/Beneficiary Form (Form 3559): This form may be required when a beneficiary is a trust. It provides necessary information about the trust and its trustee to ensure the beneficiary designation is clear and enforceable.
  • Trust Certification or Trust Agreement pages: For policies involving a trust as a beneficiary or owner, documentation to certify the trust's existence and details is often necessary. This may include significant pages from the trust agreement to validate the intended beneficiary designation.
  • Divorce Decree or Court Order documentation: In cases where divorce impacts beneficiary designations, submitting a divorce decree can clarify the intent to designate an ex-spouse or children as beneficiaries. This ensures that the form aligns with any legal requirements stemming from the divorce.

Each of these forms is essential for ensuring that the Mony Change Beneficiary form is correctly processed and that the designated beneficiaries or owners receive their intended benefits without complications. It is advisable to read through all accompanying documents carefully and consult with a professional if any uncertainties arise.

Similar forms

  • Last Will and Testament: Like the Change Beneficiary form, a Last Will outlines how a person's assets will be distributed after their death. Both documents involve specifying beneficiaries—who will receive what—though the Will covers a broader range of assets beyond just insurance proceeds.

  • Power of Attorney (POA): A Power of Attorney grants someone the authority to make decisions on another's behalf. Just as the Change Beneficiary form designates who receives benefits, the POA designates who has authority over financial and legal matters if the original party is incapacitated.

  • Trust Agreement: A Trust Agreement allows assets to be managed by a trustee for the benefit of beneficiaries, similar to how the Change Beneficiary form specifies who receives insurance benefits. Both are used to designate how assets should be handled, often for tax efficiency and to avoid probate.

  • Insurance Policy Assignment Form: An Insurance Policy Assignment Form transfers ownership rights of an insurance policy. While the Change Beneficiary form changes who benefits from the policy's payout, the Assignment Form changes who owns and controls the policy.

Dos and Don'ts

When filling out the Mony Change Beneficiary form, follow these guidelines to ensure a smooth process:

  • Do use the full legal name of each beneficiary. Avoid nicknames or abbreviations.
  • Don't forget to include the relationship of each beneficiary to the insured. This is a necessary detail.
  • Do consider designating a secondary beneficiary. Although optional, it can be beneficial for clarity.
  • Don't leave any section blank. If something does not apply, indicate "N/A" instead of skipping it.
  • Do provide current addresses and Social Security numbers for each beneficiary. This information is crucial for processing.
  • Don't forget to sign and date the form. Missing signatures can delay processing significantly.
  • Do review the form for any errors before submitting. Even small mistakes can lead to complications.

Misconceptions

  • Misconception 1: The Mony Change Beneficiary form is only for life insurance policies.

    • This form can change beneficiaries or rightsholders for various types of policies, not just life insurance. It applies to any policy offered by Mony Life Insurance Company.

  • Misconception 2: Once a beneficiary is named, it cannot be changed.

    • Beneficiaries can be changed at any time. Filing a new Change Beneficiary form updates the designation according to your current wishes.

  • Misconception 3: You must designate a contingent beneficiary.

    • While it is recommended to designate a contingent beneficiary in case the primary beneficiary passes away, it is not mandatory. You may leave the space blank if you choose.

  • Misconception 4: All beneficiaries must be living at the time of designation.

    • While it's preferred to designate living beneficiaries, the Mony form allows you to specify deceased individuals. If all beneficiaries are deceased at the time of the insured's death, the estate's executors or administrators typically become the final beneficiary.

  • Misconception 5: A divorce automatically revokes a spouse’s beneficiary designation.

    • In most states, a divorce does not automatically remove an ex-spouse as a beneficiary. A new Change Beneficiary form is needed if you wish to change or remove an ex-spouse from the designation.

  • Misconception 6: The bank account information is not required.

    • New rightsholders must provide their bank account information if they are not U.S. citizens. This information is crucial for verifying the identity of the new owner.

  • Misconception 7: You can use any name for beneficiaries.

    • Beneficiaries should be listed with their full legal names. Using abbreviations or nicknames may create issues in validating the designation.

  • Misconception 8: You do not need to provide a relationship for each beneficiary.

    • Each named beneficiary must include their relationship to the insured. This detail helps clarify the intent behind the designation.

  • Misconception 9: The Change Beneficiary form cannot be used for tax-qualified plans.

    • This form is indeed not acceptable for changing beneficiaries on tax-qualified plans. Separate processes must be followed for these types of accounts.

Key takeaways

Filling out and using the Mony Change Beneficiary form can seem like a complex task. However, understanding a few key points can streamline the process and ensure that your intentions are clearly communicated.

  • Ensure accurate beneficiary designations. Use full legal names of beneficiaries and specify their relationships to the insured.
  • Decide whether you need a primary and contingent beneficiary. It's recommended to include both for clarity.
  • Review the exemptions carefully. This form cannot be used for certain policies, like Disability Insurance Policies and Employee Benefit Plans.
  • Be mindful of tax implications. Consulting an attorney can be beneficial when there are complexities, such as transfers involving multiple generations or non-insured beneficiaries.
  • A divorce does not automatically revoke existing beneficiary designations. If you wish to change a beneficiary due to divorce, follow the correct procedures to avoid unwanted outcomes.

By keeping these points in mind, you can confidently navigate the Mony Change Beneficiary form and protect your beneficiaries’ interests.

Browse Other Templates

Edd Payroll - Retaining documentation related to the DE459 protects corporate interests over time.

How Much Is an Address Change on Your License - The MV 232 is essential for keeping your personal information current with state authorities.