Accidental Death and Dismemberment (AD&D) beneficiary designation change forms
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If you have coverage through your employer or plan sponsor, use our workplace insurance forms instead.
Make a change
Use this form to change the beneficiary or beneficiaries on your Accidental Death and Dismemberment (AD&D) plan. You'll find instructions on how to return the completed form on the form itself.
Download this form and print it, or fill it out in Adobe Reader XI or higher (not your browser) and save.
Use this form to designate one or more beneficiaries in the case of your accidental death.