Beneficiary Designation Form
(Life Insurance)

The completed form must be sent to the insurer for approval (along with copies of all enrollment forms, beneficiary changes, and absolute assignments) in any of the following situations:

• If the designation differs from the examples on the reverse side of the form,
• If the coverage has been assigned,
• If the previous beneficiary was irrevocable, or
• If the insurer maintains all the beneficiary designation records for your plan (including all individual policies).
  
  

Employee Benefits insurance products and services in the U.S. are provided by ReliaStar Life Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY). Within the State of New York, only ReliaStar Life Insurance Company of New York is admitted, and its products issued. Both are members of the ING family of companies. Product availability and specific provisions may vary by state. Each insurer is solely responsible for the financial obligations under the policies or contracts it issues.