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Verizon Beneficiary Form 2006-2023
(designations such as wills, estates, trustees), please contact
your HR representative or Assurant Employee Benefits for assistance.
PRIMARY BENEFICIARY(IES): All beneficiaries named in this section will be considered primary. Proceeds will be
paid in equal shares to these primary beneficiaries who survive you unless you indicate percentages. Percentages
must equal 100%.*
Relationship to
Insured
Name (last, first, m.i.)
Relationship to Insured Address
Date of Birth
SECONDARY BENEFICIARY(IES):...
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