Child Life Insurance Beneficiary Change Document
Policy Information
Policy Number
Policyholder Name
Child Insured Name
Current Beneficiary(ies)
Name(s)
Relationship to Insured
New Beneficiary(ies) Information
Full Name
Date of Birth
Relationship to Insured
Percentage (%)
Type
Primary
Contingent
Authorization
Policyholder Signature
Date
Additional Comments or Instructions