Fillable ABSOLUTE ASSIGNMENT OF GROUP LIFE INSURANCE (Lincoln Financial Benefits)

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ABSOLUTE ASSIGNMENT OF GROUP LIFE INSURANCE (Lincoln Financial Benefits)

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Page 1 of 2
GLA-01859 7/08
ABSOLUTE ASSIGNMENT OF GROUP LIFE INSURANCE
A. Group Life Insurance Plan (Plan): ___________________________________________________________________________
(Print Name of Employer)
Insured’s Name: _____________________________________________________ Insured’s SSN: ___________________
Address: ________________________________________________________________________________________________
Street, City, State Zip
I hereby assign any and all rights I have in the coverages provided under the Plan described above. Such rights include, but are not limited
to, any right of conversion for such benefits, the right to make any requisite contributions under said Plan, the right to change the beneficiary
and the right to elect any available settlement option to:
_______________________________________________________________________________________________________
(Print Name of Assignee)
_______________________________________________________________________________________________________
Address
This assignment relates to my rights under any insurance policy that may provide insurance coverage under the Plan. I have read the
explanations and instructions set forth on the reverse side of this form. I agree that neither the Employer nor Lincoln Financial Group (or their
agents, representatives, or employees) assume responsibility for the validity or sufficiency of this assignment. I further agree that this
assignment shall take effect on the date it is recorded by Lincoln Financial Group.
Executed this date of ____________________________ _________________________________________________
(Month, Day, Year) Signature of Assignor
Designation of Beneficiary
B. Effective the date of this assignment, the above assignor hereby revokes any previous designation pertaining to the Plan. I
hereby designate the following as beneficiaries under this Plan:
Name of Primary Beneficiary: _______________________________________________________________________________
Relationship to Insured: ___________________________________________________________________________________
Name of Contingent Beneficiary: ____________________________________________________________________________
Relationship to Insured: ___________________________________________________________________________________
Spouse Waiver for Assignment and Beneficiary Designation of Group Life Benefits
C. Please read the following section carefully. The spouse of the assignor should sign below IF the assignor is making an
assignment or beneficiary designation to a person other than his/her spouse AND the assignor is a resident of one of the
following Community Property states: AZ, CA, ID, LA, NV, NM, PR, TX, WA, WI.
I, spouse of the assignor, hereby consent to this assignment and beneficiary designation and waive and release any and all community
property rights in and to the subject matter of the assignment/beneficiary designation and to any employee contributions thereto, now and
hereafter made from community funds.
_____________________________________________________ ______________________________________________
Signature of Spouse Name of Spouse - Please Print
_____________________________________________________ ______________________________________________
Date (Month, Day, Year) Notary Public
Subscribed and sworn before me this ______________ day of ___________________________, __________
My commission expires: _________________________ (SEAL)
To be completed by the Employer To be completed by Lincoln Financial Group
Signature: _______________________________________________ Signature: _____________________________________
Title: ___________________________________________________ Title: __________________________________________
Date: ___________________________________________________ Date: __________________________________________
The Lincoln National Life Insurance Company, PO Box 2649, Omaha, NE 68103-2649
toll free (800) 423-2765
www.LincolnFinancial.com
Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates.
Page 2 of 2
GLA-01859 7/08
INSTRUCTIONS
(Absolute Assignment)
An assignment is a voluntary act, the legal effect of which depends upon the expressed purpose and intent of
the assignor. This assignment form is for the convenience of certificate holders. It can be used properly only
if it is read and considered by the assignor, in the light of his or her special situation. The Lincoln National Life
Insurance Company and the policyholder can assume no responsibility for an assignment, because they have
no way of knowing the assignor’s purpose and intent. Therefore, the assignor is urged to consult an attorney
before completing this form.
The following are some specific explanations and instructions concerning this form and its use:
1. NATURE OF FORM. This is an absolute assignment form. It should not be used in connection with collateral
or viatical assignments.
2. BENEFICIARY DESIGNATION. The assignor may change the beneficiary on this form before the assignment
is recorded, provided the previous designation is revocable. Once the assignment has been recorded, the
assignor can no longer change the beneficiary. After the assignment is recorded, only the assignee can
change the beneficiary, and then only if the previous designation is revocable.
3. CONVERSION. Once the assignment has been recorded, the assignor cannot subsequently effect a
conversion. After the assignment is recorded, only the assignee can apply for a conversion, and then only
when the conversion provision would have been available to the assignor, in the absence of this assignment.
4. COMMUNITY PROPERTY. In some states community property is an established form of ownership as
between spouses. Where applicable, the consequences of that form of ownership must be considered in
making an assignment and therefore, we recommend that Section C of the form be completed prior to
submitting this assignment.
5. PROCEDURE.
a. The signature of the assignor must be in ink and should appear exactly as the name is given in the
certificate. Exception: If the assignor is a woman and has changed her name due to marriage or
divorce, the certificate was issued, her current surname should be added to her name as given in
the certificate.
b. The date on which the assignor signs must be included in the space provided.
c. The Employer must sign off on this assignment before the form can be validated by The Lincoln
National Life Insurance Company.
d. Complete this form in triplicate. Send all three copies to the address shown on the form. This
assignment is not effective until it is recorded by The Lincoln National Life Insurance Company.
e. If the assignor is naming a Trust as the assignee, please submit a copy of the Trust along with this
assignment.
After The Lincoln National Life Insurance Company records this assignment, two copies will be returned
to the Employer, who should then:
a. note the assignment on their records and retain one copy of the assignment; and
b. inform the assignee of the assignment and release the other copy of the form for attachment
to the certificate.
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ABSOLUTE ASSIGNMENT OF GROUP LIFE INSURANCE (Lincoln Financial Benefits)

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Completed 9 February 2021

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