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Get 5star Life Insurance Beneficiary Change Form

Lace a check mark next to the policies to be affected). Policy # Insured Owner Please place a check mark next to the changes being made. 1. REQUEST TO CANCEL COVERAGE I , owner of the above policy(s) would like to cancel the policy which I have marked. 2. CHANGE OF BENEFICIARY I hereby revoke any previous designation of beneficiaries and request that the life insurance benefit payable at my death be paid in accordance with the designation be.

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