Beneficiary Designation Form

(Life Insurance)

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

  • If the designation differs from the examples on the reverse side of the form,
  • If the coverage has been assigned,
  • If the previous beneficiary was irrevocable, or
  • If the insurer maintains all the beneficiary designation records for your plan (including all individual policies).
Form NameForm Number

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

7384w (114834)

Beneficiary Designation form for group or individual life policies issued by ReliaStar Life Insurance Company of New York

47716f (116371)

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