Download Beneficiary Designation Form For Spouse/Child Rider * * * * * * *

Beneficiary Designation Form
For Spouse/Child Rider
Is this beneficiary designation for the
Spouse Rider
*
Child Rider
Both Spouse and Child
*
Certificate/Policy Number
*
Spouse’s Name
*
Owner’s Name
Spouse’s Date of Birth
(note we do not need the name or date of birth of your
child/children)
ALL SIGNATURES MUST BE WRITTEN IN INK. NAMES SHOULD BE WRITTEN AS THEY APPEAR ON THE POLICY.
Contingent Beneficiary(ies)
Primary Beneficiary(ies)
Change Beneficiary: Please print legibly. By completing this designation, I hereby revoke all previous designations for this
certificate and request that the death benefit for my spouse rider be paid to:
Social Security # Relationship to Insured
Full Name(s) ( PLEASE PRINT OR TYPE)
Percent
%
%
%
†
Full Name(s) ( PLEASE PRINT OR TYPE)
Total Percentage Must Equal 100%
Social Security #
Relationship to Insured
Percent
%
%
%
†
Total Percentage Must Equal 100%
I understand the above request(s) for service will not become effective until the request is received by Metropolitan Life Insurance
Company and approved in accordance with the terms of the certificate and to the specified provision on page 2:
*
*
Certificate Owner
(If firm or corporation, signature of authorized officer. If
owned by a trust, signature of trustees)
Date signed
*
Insured’s Date of Birth
* Required Field
Assignee (This is only required if you have assigned your policy
to a person or corporation. If firm or corporation, signature of
authorized officer)
GENERAL PROVISIONS
The requested change(s) shall be effective on the date the Owner signed this form, but subject to the rights of any assignee of record with the Company
and subject to any payment made by the Company before such changes shall have been acknowledged by Metropolitan Life Insurance Company, to
establish the beneficiary designations for proceeds payable at death of the insured, as herein stated.
Any certificate provisions requiring certificate endorsements to make the changes specified herein are waived by the Owner and by the Company.
BENEFICIARY CHANGE FORM Page 2
BENEFICIARY DESIGNATION PROVISIONS & DEFINITIONS
It is understood that, unless otherwise provided, proceeds becoming payable to two or more beneficiaries of the same class shall be divided equally
among all surviving beneficiaries of that class. Unequal shares shall be distributed proportionately to all surviving beneficiaries of that class.
The Company may rely on an affidavit by any responsible person to determine the identity or the nonexistence of any beneficiaries not identified by
name. If a beneficiary is a partnership, such beneficiary shall be the partnership as constituted at the death of the insured.
Assignee. The person or business to whom a right or rights under an insurance certificate are transferred by means of an assignment.
Assignment. The transfer of ownership of life insurance to another individual, corporation, or trustee. If your insurance has been assigned, the
assignee(s) must sign to make a designation.
Irrevocable Beneficiary. No irrevocable beneficiary designation may be changed or other ownership rights exercised without the written consent of the
beneficiary. If the beneficiary dies before the insured, all rights of the beneficiary shall vest in the owner, unless otherwise provided.
Owner. The person designated as the owner of the certificate, with all rights contained in the certificate. The owner is so designated on the certificate
application and may or may not be the insured.
Trust Beneficiary. If any trust or trustee is named as beneficiary, the Company shall be entitled to rely on any statements or documents furnished by the
trustee and shall not be obligated to inquire into the validity, general terms or proper administration of the trust. Payment under the paragraphs below
shall fully discharge the Company to the extent of such payment. Such trustee designations shall not affect the owner’s rights under the certificate,
including the right to change the beneficiary.
Trust for Minor Beneficiary. The original or successor trustee for a minor beneficiary shall serve without bond and exercise all rights and receive all
proceeds for the minor beneficiary’s education, support, maintenance and general welfare. The trust shall terminate at majority or upon prior death of the
minor beneficiary, and any funds then held by the trustee shall be paid in one sum to the beneficiary or the beneficiary’s estate.
Trust Under Will. Upon receipt by Metropolitan Life Insurance Company, certified copies of the Last Will and Testament of the testator named in the
beneficiary designation and the order admitting it to probate, the Company will pay the proceeds to the trustee if the created trust is capable of receiving
the proceeds. If, before receiving such documents, the Company receives satisfactory proof that the testator died intestate, died leaving a will which
created no trust capable of receiving the proceeds, or was a person other than the insured and survived the insured, then payment shall be made to the
owner, unless otherwise provided.
Trust Under Separate Written Trust Agreement. Upon receipt by Metropolitan Life Insurance Certificate, written statement from the trustee named
in the beneficiary designation that the agreement is in force and its terms permit the trustee to accept the proceeds, the Company will pay the proceeds to
the trustee. If, before receiving this statement, the Company receives satisfactory proof that the trust agreement is not in effect or does not permit the
trustee to receive the proceeds, then payment shall be made to the owner unless otherwise provided.
The above request is hereby acknowledged and accepted by Metropolitan Life Insurance Company.
Group Universal Life (GUL) is issued by Metropolitan Life Insurance Company, New York, NY 10166. MetLife's standard Certificate Forms include:
Certificate Forms G.9704(2009); G.9704A(2009). Coverage may also be provided on MetLife's previous standard Policy Forms 30024 (1/95); DE3002407 (2/2008); FL-3002409 (5/2005); IN-3002413 (1/95); KS-3002415 (1/95); LA-3002417 (2/2008); MN-3002422 (1/95); MS-3002423 (5/2005); NY3002431 (5/2005); OK-3002435 (1/95); OR-3002436 (2/2008); PA-3002437 (1/95); SD-3002440 (1/95); TX-3002472 (5/2005).
Group Variable Universal Life insurance (GVUL) issued by Metropolitan Life Insurance Company (MLIC), New York, NY 10166, and distributed by
MetLife Investors Distribution Company (MLIDC) (member FINRA), Irvine, CA 92614. Securities, including variable products, offered through MetLife
Securities, Inc. (MSI) (member FINRA/SIPC), 1095 Avenue of the Americas, New York, NY 10036. MLIC, MLIDC and MSI are MetLife companies.
MetLife’s standard Certificate Forms, available on or after 5/1/09 include: Certificate Forms G.24300(2003); G.24300A(2003); NY-G.24300-STOCK and
G.24300A-STOCK. Coverage may also be provided on MetLife’s previous standard Policy Forms 30037(6/96); in FL: 3003709(5/2005); IN:
3003713(6/96); MA: 3003720(6/96); MD: 3003719(6/96); MN: 3003722(6/96); MS: 3003723(5/2005); NE: 3003726(6/96); NY: 3003731(5/2005); OK:
3003735(6/96); OR: 3003736(5/2005); PA: 3003737(6/96); SC: 3003739(6/96); SD: 3003740(6/96); and in TX: 3003772(5/2005). Voluntary Enriched
Life (VEL) is issued by Metropolitan Life Insurance Company, New York, NY 10166. MetLife's standard Policy Forms include 30024 (1/95); FL-3002409
(5/2005); IN-3002413 (1/95); KS-3002415 (1/95); MS-3002423 (5/2005); OK-3002435 (1/95); PA-3002437 (1/95); TX-3002472 (5/2005) and 30007
(10/86); OK-3000735; TX-3000742 (10/86).
Send this form to: Metropolitan Life Processing Center
P.O. Box 3867 • Scranton, PA 18505-0867 • Phone: 800-756-0124 • Fax: 866-347-4483
P926603exp2014/09