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Get Assurity Life Insurance Company Beneficiary Form

S Name Policy Number Owner s Home/Cell Phone ( ) /( ) Owner s Business Phone ( ) The undersigned policyowner hereby revokes any previous beneficiary designation and any optional mode of settlement with respect to any death benefit proceeds payable at the death of the insured. Any such proceeds shall be paid as shown below. First, funds are paid to all primary beneficiaries who are living/existing when the insured dies. If no primary beneficiaries are living/existing when th.

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