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Ke all former bene ciary designations and request that Standard Insurance Company change the bene ciary(ies) as indicated for the policy(ies) identi ed. 1 Contract Identi cation POLICY NUMBER(S) ANNUITANT NAME(S) 2 Primary Bene ciary(ies) Designation PERCENT NAME PERCENT PERCENT PERCENT PERCENT ADDRESS RELATIONSHIP STATE ZIP CODE SSN (or TIN) BIRTH/TRUST DATE RELATIONSHIP STATE ZIP CODE SSN (or TIN) BIRTH/TRUST DATE RELATIONSHIP STATE ZIP CODE SSN (or TIN) BI.

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