Form SGLV8286S "Servicemembers' Group Life Insurance Supplemental Sgli Beneficiary Form - Prudential Insurance Company of America"

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Download Form SGLV8286S "Servicemembers' Group Life Insurance Supplemental Sgli Beneficiary Form - Prudential Insurance Company of America"

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Save Completed Form
Clear Form
Office of Servicemembers'
Group Life Insurance
Servicemembers’ Group Life Insurance Supplemental SGLI Beneficiary Form
1. About You
Print Name (First, Middle, Last)
Rank, title or grade
Social Security Number
Current Amount of SGLI Coverage
Duty Location
Branch of Service
2. About Your Beneficiaries
Date (month day year)
The beneficiaries listed below are in addition to those listed on my completed SGLV 8286.
Share to
Payment Option
each
(Lump sum* or
Primary
(% or $
Social Security Number
Relationship
36 equal monthly
Name and Address
(If available)
to you
amounts)
payments
1.
2.
3.
4.
Secondary
1.
2.
3.
4.
Service Member’s Signature
Date
* If the insured member elects a lump sum payment, the beneficiary(ies) will be given the option of receiving the lump sum payment through the Prudential Alliance Account
,
®
by check, or Electronic Funds Transfer (EFT). Alliance Account is not available for payments less than $5,000, payments to individuals residing outside the United States and
its territories, and certain other payments. These will be paid by check.
The Bank of New York Mellon is the Administrator of the Prudential Alliance Account Settlement Option, a contractual obligation of The Prudential Insurance Company of America,
located at 751 Broad Street, Newark, NJ 07102-3777. Draft clearing and processing support is provided by The Bank of New York Mellon. Alliance Account balances are not
insured by the Federal Deposit Insurance Corporation (FDIC). The Bank of New York Mellon is not a Prudential Financial company.
GL.2010.251 Ed. 06/2014
27402-1012
SGLV 8286S
Page 1 of 1
Print Form
Save Completed Form
Clear Form
Office of Servicemembers'
Group Life Insurance
Servicemembers’ Group Life Insurance Supplemental SGLI Beneficiary Form
1. About You
Print Name (First, Middle, Last)
Rank, title or grade
Social Security Number
Current Amount of SGLI Coverage
Duty Location
Branch of Service
2. About Your Beneficiaries
Date (month day year)
The beneficiaries listed below are in addition to those listed on my completed SGLV 8286.
Share to
Payment Option
each
(Lump sum* or
Primary
(% or $
Social Security Number
Relationship
36 equal monthly
Name and Address
(If available)
to you
amounts)
payments
1.
2.
3.
4.
Secondary
1.
2.
3.
4.
Service Member’s Signature
Date
* If the insured member elects a lump sum payment, the beneficiary(ies) will be given the option of receiving the lump sum payment through the Prudential Alliance Account
,
®
by check, or Electronic Funds Transfer (EFT). Alliance Account is not available for payments less than $5,000, payments to individuals residing outside the United States and
its territories, and certain other payments. These will be paid by check.
The Bank of New York Mellon is the Administrator of the Prudential Alliance Account Settlement Option, a contractual obligation of The Prudential Insurance Company of America,
located at 751 Broad Street, Newark, NJ 07102-3777. Draft clearing and processing support is provided by The Bank of New York Mellon. Alliance Account balances are not
insured by the Federal Deposit Insurance Corporation (FDIC). The Bank of New York Mellon is not a Prudential Financial company.
GL.2010.251 Ed. 06/2014
27402-1012
SGLV 8286S
Page 1 of 1