Beneficiary Designation

The completed form must be sent to the insurer for approval (along with copies of all enrollment forms or applications, beneficiary changes and assignments) in any of the following situations:

  • If the designation differs from the examples on page 2 of the form,
  • If the coverage has been assigned,
  • If the previous beneficiary was irrevocable,
  • If coverage is under an individual policy, or
  • If the insurer maintains all the beneficiary designation records for your plan.
Form for Association plansForm Number

Beneficiary Designation Change form for group or individual life policies issued by ReliaStar Life Insurance Company

7384w  (114834)

Beneficiary Designation form for policies issued by ReliaStar Life Insurance Company of New York

47716f (116371)

Ad Log #8622