Form 29-336 Designation of Beneficiary

OMB Approved No. 2900-0020
Respondent Burden: 10 minutes

IMPORTANT - SEE INSTRUCTIONS ON REVERSE
DESIGNATION OF BENEFICIARY
GOVERNMENT LIFE INSURANCE

DO NOT WRITE IN SPACE BELOW - FOR VA USE ONLY
ENTERED BY VA

DATE RECORDED

SIGNATURE OF VA INSURANCE OFFICIAL

1A. NAME OF INSURED AND MAILING ADDRESS FOR INSURANCE PURPOSES (Type or print)

(First,Middle,Last Name)
2A. INSURANCE FILE NUMBER

(Number and street or rural route)

F
2B. SOCIAL SECURITY NUMBER

(City or P.O., State and ZIP Code)
1B. IS THIS CHANGE OF ADDRESS FOR YOUR INSURANCE?

YES

3. DAYTIME TELEPHONE NUMBER (Include
Area Code)

(

NO

)

4. BENEFICIARY DESIGNATION
A. SHOW FULL NAME AND ADDRESS OF EACH
BENEFICIARY ENTERED IN THE PRINCIPAL AND
CONTINGENT BENEFICIARY AREAS BELOW

B. BENEFICIARY’S SOCIAL
SECURITY NO. (If known See
Instruction No. 5 on reverse)

D. SHARE TO EACH
C. RELATIONSHIP
(Use fractions such as
TO INSURED
1/2, 2/3, or "all")

E. OPTION FOR
EACH

PRINCIPAL

LUMP SUM
LUMP SUM
LUMP SUM
LUMP SUM
OR TO SURVIVORS
CONTINGENT
(Person(s) who get proceeds if all of the Principal Beneficiaries
die before the insured. If none, write "none")

LUMP SUM
LUMP SUM
LUMP SUM
LUMP SUM
OR TO SURVIVORS
5. REMARKS (Include any additional information which will clarify your intent regarding the payment of your insurance. Also, list the policy number of any policy
on which the beneficiary is not to be changed)

I understand that this change cancels all prior beneficiary and option selections; and unless indicated in Item 5, Remarks, this change applies to
all Government Life Insurance policies under the above file number.
6. SIGNATURE OF INSURED (Do NOT print) (Power of Attorney signatures are NOT acceptable)

7. DATE

8. NAME AND ADDRESS OF WITNESS (Type or print)

If you have any questions concerning designating a beneficiary, call us toll-free at 1-800-669-8477
VA FORM
DEC 2005

29-336

SUPERSEDES VA FORM 29-336, FEB 2003,
WHICH WILL NOT BE USED.

DEPARTMENT OF VETERANS AFFAIRS GOVERNMENT LIFE INSURANCE
IMPORTANT INFORMATION AND INSTRUCTIONS FOR NAMING BENEFICIARIES
In order to protect your beneficiary(ies), it is important to keep your Beneficiary Designation up to date. A properly completed, current
designation filed with your insurance records will ensure that your insurance will be paid to the person(s) you want to get it. The
information and instructions on this page are provided to help you complete the Beneficiary Designation on the reverse side of this form.
1. You have the right to change the beneficiary(ies) at any time without the knowledge or consent of the prior beneficiary(ies). A state
court order or divorce decree cannot restrict this right and is not binding on you.
2. You may name as beneficiary(ies) any person, firm, corporation or other legal entity including your estate.
3. This designation will cancel and replace all previous designations for all of your policies. Any policies you wish to be excluded from
this designation must be listed in Item 5, "Remarks" on the designation form.
4. When inserting a beneficiary’s name, please provide the first name, middle initial, and last name. For example, use John J. Smith. For
married persons, use Mary K. Smith, not Mrs. John J. Smith.
5. DO NOT DELAY SENDING THIS DESIGNATION if you do not have a beneficiary’s social security number handy. Your
designation is still valid even if you do not know the social security number, so send this designation right away. Having the
beneficiary’s social security number will help us locate the beneficiary.
6. If you name more than one principal or contingent beneficiary, please show the share, in fractions such as 1/2 or 1/3, etc. which each
is to receive and make certain that the shares total "1". Equal shares will be paid unless you designate otherwise.
7. The "LUMP SUM" preprinted in the "option for each" block means the beneficiary(ies) may choose to receive the insurance in one
lump sum or in monthly payments. For information on monthly payment options call our toll-free number below.
8. The preprinted phrase "or to survivor(s)" means that the share of a beneficiary(ies) who dies before you will be paid to the surviving
beneficiaries. For example, if you name three principal beneficiaries and one dies before you, the share will be paid to the other two
principal beneficiaries, not to any contingent beneficiaries. For information about alternatives to the automatic survivorship clause,
please call our toll-free number below.
9. If no beneficiaries survive you or none are selected, the insurance proceeds will be paid to your estate.
10. MAILING INSTRUCTIONS - Send this form promptly upon completion to the address below. A copy will be mailed to you as
evidence of receipt by VA. The address is:
VARO&IC (B&O)
P.O. BOX 7208
PHILADELPHIA, PA 19101
IF YOU HAVE QUESTIONS CONCERNING YOUR GOVERNMENT LIFE INSURANCE, PLEASE FEEL FREE TO CALL

PRIVACY ACT NOTICE: The VA will not disclose information collected on this form to any source other than what has been
authorized under the Privacy Act of 1974 or Title 5, Code of Federal Regulations 1.526 for routine uses identified in the VA system
of records, 36VA00, Veterans and Armed Forces Personnel U.S. Government Life Insurance Records - VA, published in the Federal
Register. Your obligation to respond is voluntary, but your failure to provide us the information could impede processing. Giving us
your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. The VA
will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by a Federal
Statute of law in effect prior to January 1, 1975, and still in effect. The responses you submit are considered confidential (38 U.S.C.
5701).
RESPONDENT BURDEN: We need this information to determine, establish or verify your eligibility for VA Insurance benefits (38
U.S.C. 5902). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 10
minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of
informtion unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this
number is not displayed. Valid OMB control numbers can be located on the OMB Internet page at
www.whitehouse.gov/library/omb/library/OMBINV.VA.EPA.html#VA. If desired, you can call 1-800-827-1000 to get information
on where to send comments or suggestions about this form.

NOTE: THIS FORM IS NOT TO BE USED FOR SERVICEMEMBERS’ OR VETERANS GROUP LIFE INSURANCE.