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RELATIONSHIP OF EACH TO THE INSURED C. AMOUNT TO EACH Fractions such as 1/2 2/3 or 3/4 D. OPTION FOR EACH 1 2 3 OR 4 E. OR TO SURVIVORS CONTINGENT Person s who get the proceeds if the principal beneficiary ies die before the insured. If none write NONE DO NOT WRITE IN THE SPACE BELOW - FOR VA USE ONLY ENTER BY VA VA FORM MAY 1999 SIGNATURE OF VA INSURANCE OFFICIAL 29-4364 SUPERSEDES VA FORM 29-4364 MAR 1999 WHICH WILL NOT BE USED.

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