GR-TR-BENE-MET1 (10/19)
Page 4 of 4
Fs/f
Charity/Organization – List the charity or organization name and not an employee of the
charity or organization. See further instructions on page 4.
Proceeds
M
%
Total proceeds for all contingent beneficiaries (H-M plus any listed on separate pages)
must equal 100%.
100%
SECTION 5: About your Trust/Charity/Organization Beneficiaries
Skip this section if you did not name a Living Trust or Charity/Organization as one of your beneficiaries.
Otherwise, please provide the information requested below on a separate page. Make sure you include the type
of beneficiary (primary or contingent) and that you sign and date these page(s).
Please include: Additional information required for Living (Inter Vivos) Trust(s):
• Trust/Charity/Organization name • Trust date
• Address • Trust Tax ID number
• Phone Number • Trustee first, middle and last name
• Type of Beneficiary (primary or contingent)
• % of proceeds you are assigning to the
Trust/Charity/Organization
SECTION 6: Signature Required
By signing below, I hereby revoke any previous designations, and I designate the person, people, or entity
named herein as beneficiaries.
Check if you are completing and signing this form as agent for the insured under a valid Power of Attorney.
Please submit a copy of the Power of Attorney with this beneficiary form.
Please Print and Sign Below
Insured/Owner First Name Middle Name
Last Name
Insured/Owner Signature Date Form Completed (mm/dd/yyyy)
Did you remember to…
ü Provide complete information for each of your beneficiaries?
ü Make sure the total “proceeds %” for your primary beneficiaries (including those on a separate
page) equals 100%? Separately, did you remember to make sure the total “proceeds %” for your
contingent beneficiaries (including those on a separate page) equals 100%?
ü Complete, sign and date any extra pages that list beneficiary information (such as Living Trust/
Charity/Organization beneficiaries)?
ü Cross out and initial any mistakes you made? (If you crossed out any answers, your signature
is not enough. You must also initial all your corrections.)
Example:
12/20/25 12/20/15 HM `
answer corrected, initials required
Please note: we cannot record your beneficiary choices unless you complete these items.
SECTION 7: How to Submit This Form
Mail:
MetLife Recordkeeping & Enrollment Services
P.O. Box 14406
Lexington, KY 40512-4406
Be sure to keep a copy of this completed form for your records.