american general life insurance company the united … · american general life insurance company...

AGL 020 (10/14)

CONTRACT/CERTIFICATE NUMBER(S): ____________________________________________________________________

OWNER: _______________________________________________ DAYTIME PHONE # ________________________________

SSN OR TAX ID: _________________________________________

I/We revoke existing designations and subject to any existing assignment, make the following Primary and Contingent Beneficiary designations as listed below:** If the Beneficiary is being changed to a TRUST, please include the Name, Date and Trustee(s) of the TRUST and complete the Certification of Trust Form (AGL 900).**

Primary Beneficiary for Owner:

Contingent Beneficiary for Owner:

Primary Beneficiary for Joint Owner:

Please complete Page 2 of this form. Failure to do so may delay your request.

Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________

SSN: ______________ DOB: __________ Relationship: _____________ Percentage: ____ Email: ______________________________

Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________ Address:________________________________________________________________________ Phone # ___________________

SSN: ______________ DOB: __________ Relationship: _____________ Percentage: ____ Email: _________________________________

American General Life Insurance Company The United States Life Insurance Company in the City of New York

Mailing Address: Annuity Service Center • P.O. Box 871 • Amarillo, TX 79105-0871 Overnight Mailing Address: Annuity Service Center • 1050 N. Western Street • Amarillo, TX 79106-7011

BENEFICIARY DESIGNATION FORM

AGL 020 (10/14)

Contingent Beneficiary for Joint Owner

Primary Beneficiary for Annuitant

Contingent Beneficiary for Annuitant

Owner’s Signature Joint Owner’s Signature (if applicable) Irrevocable Beneficiary (if applicable) Date

Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Name: ____________________________________________________________________________________________________

Address:________________________________________________________________________ Phone # ___________________


Administrator for Renaissance Life and Health Insurance Company of America • Administrator for John Alden Life Insurance Company

american general life insurance company the united … · american general life insurance company...

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