IFAMM Change of Beneficiary Form
In order to make a change in the beneficiary we have on file, we must have a signed statement from you requesting a change. We value your membership and thank you for uniting with us.
I, type your name:
*
First Name
Last Name
from the State of
*
a member of Lodge/Chapter Name:
*
and my Roll # is:
*
wish to change my beneficiary designation to:
*
First Name
Last Name
Relationship (i.e., spouse, mother, father, son, daughter, niece, nephew, etc.):
*
Do you wish for this change to be made for all Departments/Houses you are a member of?
Yes, please change in all Departments/Houses.
No, just this one.
Please change in the following Department/House:
Please change in the following Department/House:
Please change in the following Department/House:
Please change in the following Department/House:
E-mail
*
example@example.com
Home Number
Format: (000) 000-0000.
Cellular Number
Format: (000) 000-0000.
Member Signature:
Today's Date
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Change of Beneficiary Form
Should be Empty: