A Pan-American Life Insurance Group Stock Company

Adding Beneficiaries to Your Policies

Mutual Trust provides space for you to include information on three primary beneficiaries and three contingent beneficiaries on its applications and change of beneficiary form, No. 4160. However, you don’t need to stop at three primary or three contingent beneficiaries. If you want to assign your death benefit proceeds to more than three beneficiaries (primary or contingent) on new applications, please write the first three beneficiaries on the application. Then, on a separate piece of paper, write the full legal name(s) of additional primary or contingent beneficiaries, their relationship to the insured, date of birth, complete address, and the percentage of proceeds you would like them to receive. (Proceeds must equal 100% for the primary beneficiaries as well as 100% for the contingent beneficiaries.) Then sign the piece of paper and record the date on it, and submit the piece of paper with your application.

For existing policies, when changing or adding beneficiaries, fill out the “Request for Change of Beneficiary Form,” No. 4160 (available on the website in the Customer Service section after you log in). Put the first three beneficiaries on the form and add any additional beneficiaries (primary or contingent) on a separate sheet of paper, like explained earlier for a new application. Be sure to sign and date it. Then submit this form and the separate sheet of paper to Mutual Trust.* For additional questions, please contact us at 800-323-7320, ext. 5060.

*No beneficiary designation request will take effect until MTL has deemed it to be properly executed and has recorded it.


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Form No. 190