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GROUP LIFE INSURANCE BENEFICIARY DESIGNATION FORM Hawaii Employer-Union Health Benefits Trust Fund This beneficiary designation cancels all prior designations. State National Insurance Company Ltd. In no case will the beneficiary designation be effective prior to January 1 2012. All proceeds will be paid in accordance with the terms of the Policy. If the Beneficiary is to be a living trust give the name and location of the trustee and the date o.

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