Get Beneficiary Designation Form - Benefits - Los Angeles Unified ...

Completing the Beneficiary Designation Form is an essential step to ensure your benefits are distributed according to your wishes. This guide provides clear, step-by-step instructions to help you fill out the form accurately and effectively online.

Follow the steps to complete the Beneficiary Designation Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the insured’s name of employer, group policy number, certificate number, and the insured’s Social Security number at the top of the form.
3. Provide the primary beneficiary designation by entering the full name, relationship, date of birth, and address for each primary beneficiary. Specify the percentage share for each beneficiary, ensuring that the total shares equal 100%.
4. If applicable, fill in the contingent beneficiary designation with the same details as required for the primary beneficiaries. Again, the total shares must equal 100%.
5. If you wish to designate a Trust(ee), complete the trust designation section with the name and address of the Trust(ee), title of the agreement, and the date it was executed. This replaces the primary and contingent beneficiary sections.
6. Sign and date the form at the bottom, providing the name of the insured or owner, daytime phone number, and current address.
7. Review the information for accuracy, then save changes, download, print, or share the completed form as needed.

Start filling out your Beneficiary Designation Form online today to ensure your benefits are designated according to your wishes.