Change
of Beneficiary Due to Death Form
-
- Complete all sections of this form and remit with a copy of the death certificate to: College Illinois!, P.O. Box 19292, Springfield, IL 62794-9292 or by fax to 1-800-519-4652. Call Customer Service, toll-free, at 1-877-877-3724, option 2, with any questions you may have. Written confirmation will be sent when the change has been processed.
Current Contact Information - Please print legibly
| College Illinois! Account Number: | ___________________________________________________________________________ |
| Current Purchaser Name: | ___________________________________________________________________________ |
| Current Beneficiary Name: | ___________________________________________________________________________ |
New Beneficiary Information - Please print legibly
| Name (First, Middle, Last, Suffix): | ___________________________________________________________________________ |
| Social Security Number: | ___________________________________________________________________________ |
| Street Address / PO Box / Apt. #: | ___________________________________________________________________________ |
| City, State, Zip: | ___________________________________________________________________________ |
| Telephone Number: | ___________________________________________________________________________ |
| Relationship to Original Beneficiary: | ___________________________________________________________________________ |
| Current Age / Grade in School: | ___________________________________________________________________________ |
| Projected College Enrollment Year: | ___________________________________________________________________________ |
| _________________________________________________________________________________________________________ | ||
| Purchaser's Signature | Date | |