How To Use Beneficiaries Designation Form & Schedule

Many separated moms and dads are required by their Separation Agreement, Divorce Order or other Court Order, to secure support payments. Rebalancing Beneficiaries Support Insurance allows a newly purchased insurance policy (through Come To Agreement Ltd.) to secure those payments while allowing additional beneficiaries such as children or a new partner to be included on the policy. Your calculations may be saved for use at a later time by joining our Free Consumer Membership.

Remember, this is a legal agreement between the Insured Party, the Support Beneficiary and the Insurance Company (new policies only). Please complete the Beneficiaries Designation Form & Schedule as accurately as possible, including all mandatory fields (*). Consider your specific requirements. Your questions may be explained more fully by a Family Lawyer or licensed Insurance Advisor.

  1. The calculator calculates automatically based on Policy Date, Support Amount and Number of Years. The Policy Amount may be greater than the Support Amount. Example: a $300,000.00 policy but securing only $200,000.00 support payments. Most often the Policy Amount and the Support Amount are the same.
  2. Read the Rollovers (?) regarding further help for each section
  3. Consider the implications regarding Irrevocable or Revocable policies by asking your Insurance Advisor or Family Lawyer.
  4. The Notification tab provides permission for an Insurance Advisor to contact the Support Beneficiary if the policy will lapse.
  5. Changing Child Support, Children’s Special Expenses and Spousal Support can affect insurance requirements. The % column and Amount column may be manually adjusted to reflect your changing circumstances. The calculator will recalculate. Please note: calculations do not allow for an amount greater than the Support Amount, either by percentage or amount.
  6. Your best “Witnesses” are your Family Lawyer or Insurance Advisor.
  7. Consumer Members or Professional Members are able to Save and Email this Form.
  8. To complete a new Form or to clear the contents of an existing Form, Press "Clear".

Form Errors


Beneficiaries Designation Form & Schedule

For Information or help completing this form please contact:
Insurance@ComeToAgreement.com | 1 (855) TO-AGREE 862-4733

By completing this section you are naming a Support Beneficiary and Rebalancing Beneficiaries to receive proceeds payable on the death of the Insured. Throughout this Form "Insurance Company" means the Insurance Company listed below, the "Proposed Insurer" is the insured person and the "Owner" will mean the owner of the policy. The Owner of the Policy and the Support Beneficiary may be the same person.

"Beneficiaries Designation Form & Schedule" is a contract between the Policy Owner and the Insurance Company and provides direction by the Owner directly to the Insurance Company. All Rebalancing Beneficiary(ies) are Contingent Beneficiaries upon death of Support Beneficiary.

Insurance Information

Support Beneficiary

Rebalancing Beneficiary (ies)

Rebalancing Schedule

Support Beneficiary

Rebalancing Beneficiary(ies)

Years Policy
Anniversary Date
% (-) Rebalancing
Amount
  Support
%
Support
Amount
  Rebalancing
%
Rebalancing
Amount
Declaration and Authorization:

By signing below I hereby direct any proceeds be paid to the Beneficiaries named according to the above rebalancing schedule. I authorize the Insurance Company to carry out the above mentioned transactions in keeping with the rights, terms and conditions of the Policy/Contract. I agree that a licensed Insurance Advisor may notify the Support Beneficiary if the policy will lapse from non-payment, if the “Notification” box is marked “Yes”. If the Rebalancing Beneficiary(ies) Section is not completed the rebalancing amount will go to the Proposed Insured’s Estate.

By signing below as Support Beneficiary I agree and hereby consent to release my irrevocable beneficiary status in relation to the above noted policy, (if “Irrevocable” is agreed to on this Form), when the Proposed Insured party’s support obligation ceases under this agreement.

A photocopy or image of the signed Beneficiaries Designation Form & Schedule/Declaration and Authorization will be as valid as the original.

I understand the Insurance Company may use third party service providers located outside Canada to process and store my personal information. To access a copy of the most recent Privacy Policy, please visit the Insurance Company's website. The Proposed Insured and Support Beneficiary accept and understand the Insurance Company may ask for further beneficiary information.

Proposed Insured
Signature:
Name:
Signed at (City/Prov):
 
Date:
 
Witness
Signature:
Name:
Date:
Support Beneficiary
Signature:
Name:
Signed at (City/Prov):
 
Date:
 
Witness
Signature:
Name:
Date:

Disclaimer:

Come To Agreement Ltd. is not owned or operated by an insurance company and is not an insurance company. Rebalancing Beneficiaries Support Insurance, is a Come To Agreement Ltd. product. Come To Agreement Ltd. is an agent for the insurance company and Rebalancing Beneficiaries Support Insurance is only sold by licensed insurance advisors.