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If you are designating a Trust as your beneficiary, signing as a Trustee, or if there have been changes to the Trust, please submit an updated Trust Verification Form (16541).

For which annuity contract?

Contract	Owner	Issue Date

Are you married?

Yes

No

Companies and Trusts require signed paper forms.

Please update and mail or fax the completed forms to Athene: Beneficiary Change Request Form (13977)

Verification forms you may also need: Pension Plan Verification Form (17982) Company, Partnership or Limited Liability Corporation (LLC) Verification (19861) Trust Verification Request Form (16541)

Athene
P.O. Box 1555, Des Moines, IA 50306-1555
Fax: 1-800-531-0038

For assistance, please call 888-266-8489 between the hours of 8:00 a.m. – 5:00 p.m. CT, Monday – Friday.

Maximum of 10 beneficiaries per type (Primary, Contingent, Tertiary).

Your summary for :

Primary Beneficiary	Allocation

Contingent Beneficiary	Allocation

Tertiary Beneficiary	Allocation

Please update required field(s) to continue.

Fields marked with * are required.

Add Beneficiary

Relationship * Select relationship.

Full Name * Enter full name.

Social Security Number or Tax ID

Date of Birth

Allocation *

%

Enter whole number from 1 to 100.

Distribution

Per stirpes

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Comments

Please confirm you would like to remove:

Allocation %

Review requested changes, then submit.

Today's Date

Insured/Annuitant

Contract Number

Owner

Primary Beneficiaries

I have read and agree to the Terms of Use and authorize the request/transaction.

Your request has been submitted. Most requests are processed within 2 business days. A confirmation email will be sent shortly.

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