29-336 Designation of Beneficiary - Government Life Insurance

OMB Control No. 2900-0020
Respondent Burden: 10 minutes
Expiration Date: XX/XX/20XX

DESIGNATION OF BENEFICIARY GOVERNMENT LIFE INSURANCE
INSTRUCTIONS FOR COMPLETING THIS FORM
NOTE: If you set up an online account at https://insurance.va.gov/home/, you can update your beneficiary designation directly online safely and instantly. You may
also download the form and complete manually. If completed manually, print the information requested in ink, neatly, and legibly to expedite processing of the form.
You can also submit through our safe and secure document upload service at https://insurance.va.gov/Home/IDU or via mail at VARO & IC (B&O), P.O BOX 8638,
PHILADELPHIA, PA 19101.
• Use this form to designate or make changes to the beneficiary(ies) of your Government Life Insurance death proceeds. This form does not apply for use in
Servicemembers' Group Life Insurance (SGLI) or Veterans' Group Life Insurance (VGLI) beneficiary designations.
• The information on this form will replace any prior beneficiary designations.
• You may name any person, firm, corporation/organization, trust, or your estate as your beneficiary. You have the right to change your beneficiary at any
time without the knowledge or consent of the prior beneficiary. A state court or divorce decree cannot restrict this right and is not binding on you. You may
change your beneficiary at any time by completing a new Government Life Insurance Beneficiary Designation form.
• This form cannot be used to reinstate your coverage if your insurance is not in force due to failure to pay timely premiums.
• If any part of the designation in either the principal or contingent beneficiary section is unclear, ambiguous, or not legally acceptable, then the previous
beneficiary designation will remain effective, or, if no prior designations exist or are invalid, the insurance will be paid based on the order of precedence.
• Any alterations, erasures, and cross-outs on this form will invalidate this designation.
• All pages must be returned at the same time with a signature on the final page to be valid.
• If you do not name a specific beneficiary or if all your designated beneficiaries pre-decease you, your insurance will be paid by order of precedence:
1) Surviving spouse,
2) Children and decedents of deceased children,
3) Parents or their surviving children (Veteran's Siblings),
4) The duly appointed executor or administrator of my estate,
5) Other next of kin based upon the laws of the Veteran's residence (domicile) at time of death.
• THIS DESIGNATION WILL APPLY TO ALL POLICIES.

SECTION I - VETERAN'S IDENTIFYING INFORMATION (All information requested in this section is required)
1. FIRST NAME - MIDDLE INITIAL - LAST NAME OF VETERAN/INSURED

3. DATE OF BIRTH (MM/DD/YYYY)

2. VETERAN/INSURED SOCIAL SECURITY NO.

4. VETERAN/INSURED MAILING ADDRESS (Number and Street or Rural Route, P.O. Box, City, State, ZIP Code and Country)
No. &
Street
Apt./Unit Number
State/Province
5. E-MAIL ADDRESS

City
Country

ZIP Code/Postal Code
6. DAYTIME TELEPHONE NUMBER (Include Area Code)

7. CHECK BOX IF YOUR
ADDRESS HAS CHANGED

8. LIST ALL POLICY NUMBERS

PRIVACY ACT INFORMATION: No insurance may be converted unless a completed application form has been received (38 U.S.C. 1904 and 1942). The VA will not

disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 5, Code of Federal Regulations
1.526 for routine uses as identified in VA system of records, 36VA29, Veterans and Uniformed Services Personnel Programs of U.S. Government Life Insurance - VA,
published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. The responses you submit are considered confidential (38 USC
5701).
RESPONDENT BURDEN: An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently

valid OMB control Number. The OMB control number for this project is 2900-0020, and it expires XX/XX/20XX. Public reporting burden for this collection of
information is estimated to average 10 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate and any other aspect of this
collection of information, including suggestions for reducing the burden to VA Reports Clearance Officer at [email protected]. Please refer to OMB
Control No. 2900-0020 in any correspondence. Do not send your completed VA Form 29-336 to this email address.
VA FORM
XXX XXXX

29-336

SUPERSEDES VA FORM 29-336, OCT 2023,
WHICH WILL NOT BE USED.

Page 1

INSTRUCTIONS FOR DESIGNATING A PRINCIPAL OR CONTINGENT BENEFICIARY (Section II through IV)
You may name more than one principal and more than one contingent beneficiary. This form allows you to name up to three principal and three contingent
beneficiaries. Please use VA Form 29-336a, Supplemental Designation of Beneficiary to add additional beneficiaries or attach a sheet of paper with your
beneficiaries clearly listed. If you attach a sheet of paper listing additional beneficiaries, it must be legible and include your name, date, and signature.
Please review the examples below designating your beneficiaries:
Individual: "Jane A Doe"
• List person by name as first name, middle name, last name. i.e.:
"Jane A Doe, not Mrs. Michael Doe"
• For multiple beneficiaries, make sure that the percentages add up to
100%.
• Use fractions or percentages, not dollar amounts when selecting
shares. You can split the proceeds equally between your listed
beneficiaries by checking the "Equal Shares" Box.
• Include address, relationship, Social Security Number. This assists us
in locating and paying the correct person.
Estate: "Estate of the Insured"
• Select "Estate" in the type of beneficiary box and list the name of the
estate in the name block. We will only pay the estate if probated. i.e.:
"Estate of John Smith" or "my estate"
• If not probated, then we will pay to other designated principal or
contingent beneficiary(ies), or order of precedence.

Funeral Home
• Simply State "Funeral Home" in the name block. The funeral home
will only receive an amount of the death proceeds equal to your
funeral expense. Any remaining proceeds will go to the other
designated principal or contingent beneficiaries or by order of
precedence. By leaving the designation general to the "Funeral
Home", we can pay whichever funeral home performs the service.
Charitable Institute or Organization: "ABC Charitable Organization"
• Select Organization in type of beneficiary block.
• Write the legal named of the Charitable organization in the name block.
• Provide the Address, city, and state of the organization to ensure
payment is made to the correct organization.
Trusts
• If you designate a trust as a principal or contingent beneficiary in
Sections II or III, you MUST also complete Section IV to provide
additional information about the trust. If Section IV is not completed,
the designation is invalid.

SECTION II - BENEFICIARY DESIGNATION INFORMATION - PRINCIPAL
Principal Beneficiaries are the person(s) or entity(ies) you choose to receive your life insurance proceeds. If a designated principal beneficiary predeceases you, the
proceeds will be paid to the remaining principal beneficiaries in equal shares or all to the sole remaining principal beneficiary. If no principal beneficiaries remain, we would
pay the contingent beneficiaries, or, if none, we would pay by order of precedence. We will pay via lump sum. If interested in other payment options, please call our toll-free
number 1-800-669-8477.

IMPORTANT - The total for all principal beneficiaries must equal 100%. If the designated shares do not add up to 100%, equal shares will be paid.
I HEREBY REVOKE ANY PREVIOUS DESIGNATION OF PRINCIPAL BENEFICIARY(IES), IF ANY, AND IN THE EVENT OF MY DEATH, DESIGNATE
THE FOLLOWING:

PRINCIPAL BENEFICIARY IDENTIFYING INFORMATION
TYPE OF BENEFICIARY (Check one)
SPOUSE

CHILD

PARENT

SIBLING

OTHER

ESTATE

CHARITABLE/ORGANIZATION

TRUST (For trusts ONLY, check this box and complete the share amount, then skip to Section IV)
FIRST NAME - MIDDLE INITIAL - LAST NAME OF PRINCIPAL BENEFICIARY

PRINCIPAL BENEFICIARY DATE OF BIRTH (MM/DD/YYYY)

PRINCIPAL BENEFICIARY SOCIAL SECURITY NUMBER

PRINCIPAL BENEFICIARY MAILING ADDRESS (Number and Street or Rural Route, P.O. Box, City, State, ZIP Code and Country)
No. &
Street
Apt./Unit Number
State/Province

City
Country

ZIP Code/Postal Code
PRINCIPAL BENEFICIARY DAYTIME TELEPHONE NUMBER (Include Area Code)

PRINCIPAL BENEFICIARY E-MAIL ADDRESS

INSURANCE PAYMENT DISTRIBUTION
NOTE: Please use percentages when identifying specific shares.

VA FORM 29-336, XXX XXXX

SHARE:

%

Page 2

SECTION II - BENEFICIARY DESIGNATION INFORMATION - PRINCIPAL (Continued)
PRINCIPAL BENEFICIARY IDENTIFYING INFORMATION
TYPE OF BENEFICIARY (Check one)
SPOUSE

CHILD

PARENT

SIBLING

OTHER

ESTATE

CHARITABLE/ORGANIZATION

TRUST (For trusts ONLY, check this box and complete the share amount, then skip to Section IV)
FIRST NAME - MIDDLE INITIAL - LAST NAME OF PRINCIPAL BENEFICIARY

PRINCIPAL BENEFICIARY DATE OF BIRTH (MM/DD/YYYY)

PRINCIPAL BENEFICIARY SOCIAL SECURITY NUMBER

PRINCIPAL BENEFICIARY MAILING ADDRESS (Number and Street or Rural Route, P.O. Box, City, State, ZIP Code and Country)
No. &
Street
Apt./Unit Number

City

State/Province

Country

ZIP Code/Postal Code
PRINCIPAL BENEFICIARY DAYTIME TELEPHONE NUMBER (Include Area Code)

PRINCIPAL BENEFICIARY E-MAIL ADDRESS

INSURANCE PAYMENT DISTRIBUTION
NOTE: Please use percentages when identifying specific shares.

SHARE:

%

PRINCIPAL BENEFICIARY IDENTIFYING INFORMATION
TYPE OF BENEFICIARY (Check one)
SPOUSE

CHILD

PARENT

SIBLING

OTHER

ESTATE

CHARITABLE/ORGANIZATION

TRUST (For trusts ONLY, check this box and complete the share amount, then skip to Section IV)
FIRST NAME - MIDDLE INITIAL - LAST NAME OF PRINCIPAL BENEFICIARY

PRINCIPAL BENEFICIARY DATE OF BIRTH (MM/DD/YYYY)

PRINCIPAL BENEFICIARY SOCIAL SECURITY NUMBER

PRINCIPAL BENEFICIARY MAILING ADDRESS (Number and Street or Rural Route, P.O. Box, City, State, ZIP Code and Country)
No. &
Street
Apt./Unit Number
State/Province

City
Country

ZIP Code/Postal Code
PRINCIPAL BENEFICIARY DAYTIME TELEPHONE NUMBER (Include Area Code)

PRINCIPAL BENEFICIARY E-MAIL ADDRESS

INSURANCE PAYMENT DISTRIBUTION
NOTE: Please use percentages when identifying specific shares.

SHARE:

%

Do not name additional principal beneficiaries in Section III of this form. Please use VA Form 29-336a, Supplemental Designation of Beneficiary to add additional
principal beneficiaries or attach a signed sheet of paper with your beneficiaries. Make sure you also include your name, date, and policy number.

VA FORM 29-336, XXX XXXX

Page 3

SECTION III - BENEFICIARY DESIGNATION INFORMATION - CONTINGENT
Contingent Beneficiaries are the person(s) or entity(ies) you choose to receive your life insurance proceeds if the principal beneficiary (ies) die before you, or, if an
organization is named principal beneficiary, it dissolves before you die. In the event that a designated contingent beneficiary predeceases you, the proceeds will be paid to the
remaining contingent beneficiaries in equal shares or all to the sole remaining contingent beneficiary. If none, then we would pay by order of precedence. We will pay via lump
sum. If interested in other payment options, please call our toll-free number 1-800-669-8477.

IMPORTANT - The total for all contingent beneficiaries must equal 100%. If the designated shares do not add up to 100%, equal shares will be paid.

CONTINGENT BENEFICIARY IDENTIFYING INFORMATION
TYPE OF BENEFICIARY (Check one)
SPOUSE

CHILD

PARENT

SIBLING

OTHER

ESTATE

CHARITABLE/ORGANIZATION

TRUST (For trusts ONLY, check this box and complete the share amount, then skip to Section IV)
FIRST NAME - MIDDLE INITIAL - LAST NAME OF CONTINGENT BENEFICIARY

CONTINGENT BENEFICIARY DATE OF BIRTH (MM/DD/YYYY)

CONTINGENT BENEFICIARY SOCIAL SECURITY NUMBER

CONTINGENT BENEFICIARY MAILING ADDRESS (Number and Street or Rural Route, P.O. Box, City, State, ZIP Code and Country)
No. &
Street
Apt./Unit Number

City

State/Province

Country

ZIP Code/Postal Code
CONTINGENT BENEFICIARY DAYTIME TELEPHONE NUMBER (Include Area Code)

CONTINGENT BENEFICIARY E-MAIL ADDRESS

INSURANCE PAYMENT DISTRIBUTION
NOTE: Please use percentages when identifying specific shares.

SHARE:

%

CONTINGENT BENEFICIARY IDENTIFYING INFORMATION
TYPE OF BENEFICIARY (Check one)
SPOUSE

CHILD

PARENT

SIBLING

OTHER

ESTATE

CHARITABLE/ORGANIZATION

TRUST (For trusts ONLY, check this box and complete the share amount, then skip to Section IV)
FIRST NAME - MIDDLE INITIAL - LAST NAME OF CONTINGENT BENEFICIARY

CONTINGENT BENEFICIARY DATE OF BIRTH (MM/DD/YYYY)

CONTINGENT BENEFICIARY SOCIAL SECURITY NUMBER

CONTINGENT BENEFICIARY MAILING ADDRESS (Number and Street or Rural Route, P.O. Box, City, State, ZIP Code and Country)
No. &
Street
Apt./Unit Number
State/Province

City
Country

ZIP Code/Postal Code
CONTINGENT BENEFICIARY DAYTIME TELEPHONE NUMBER (Include Area Code)

CONTINGENT BENEFICIARY E-MAIL ADDRESS

INSURANCE PAYMENT DISTRIBUTION
NOTE: Please use percentages when identifying specific shares.

VA FORM 29-336, XXX XXXX

SHARE:

%

Page 4

CONTINGENT BENEFICIARY IDENTIFYING INFORMATION
TYPE OF BENEFICIARY (Check one)
SPOUSE

CHILD

PARENT

SIBLING

OTHER

ESTATE

CHARITABLE/ORGANIZATION

TRUST (For trusts ONLY, check this box and complete the share amount, then skip to Section IV)
FIRST NAME - MIDDLE INITIAL - LAST NAME OF CONTINGENT BENEFICIARY

CONTINGENT BENEFICIARY DATE OF BIRTH (MM/DD/YYYY)

CONTINGENT BENEFICIARY SOCIAL SECURITY NUMBER

CONTINGENT BENEFICIARY MAILING ADDRESS (Number and Street or Rural Route, P.O. Box, City, State, ZIP Code and Country)
No. &
Street
Apt./Unit Number
State/Province

City
Country

ZIP Code/Postal Code
CONTINGENT BENEFICIARY DAYTIME TELEPHONE NUMBER (Include Area Code)

CONTINGENT BENEFICIARY E-MAIL ADDRESS

INSURANCE PAYMENT DISTRIBUTION
NOTE: Please use percentages when identifying specific shares.

SHARE:

%

Please use VA Form 29-336a, Supplemental Designation of Beneficiary to add additional contingent beneficiaries or attach a signed sheet of paper with your
beneficiaries clearly listed. Make sure you include your name, signature, and date.

SECTION IV - TRUST DESIGNATIONS
Complete this section if a Trust has been named as a principal or contingent beneficiary in Section II or III. Fill in the name and address for each trustee. Fill in the title and
date of the Trust Agreement in the space provided. Any time the trust is amended with a new date, a new designation MUST be submitted to be valid. If there are
amendments after the trust is designated or the trust is no longer funded, then we cannot pay the trust and will pay to other designated principal or contingent beneficiary(ies),
or order of precedence.

INSTRUCTIONS:
• Select "Trust" in the type of beneficiary box in Section II (If designated as principal beneficiary) or III (If designated as contingent beneficiary)
• Indicate the percentage to be assigned to the trust in Section II or III under Insurance Payment Distribution
• Then, complete the section below:
EXAMPLES ON HOW TO DESIGNATE VARIOUS TRUSTS:
• Inter Vivos Trust (A trust you set up during your Lifetime)
i.e.: Name of Trust: "John A Smith Trust Agreement", Date of Trust: "September 18, 2023"
• Testamentary Trust (A trust that is set up when you die, according to the terms in your will per probate laws)
i.e.: "Trust as provided in my Last Will and Testament"
• Special Needs Trust: Trust created to provide assets to support an individual with disability or illness.
i.e.: Name of Trust: "The John Smith Special Needs Trust", Date of Trust: "September 18, 2023"
NAME OF TRUST

DATE (MM/DD/YYYY)

The following information is used to assist VA in obtaining a claim. It is NOT part of the designation.
1a. TRUSTEE NAME (FIRST, MI, LAST)

2a. TRUSTEE NAME (FIRST, MI, LAST)

1b. TRUSTEE ADDRESS

2b. TRUSTEE ADDRESS

1c. TRUSTEE DAYTIME PHONE NUMBER

2c. TRUSTEE DAYTIME PHONE NUMBER

1d. TRUSTEE EMAIL ADDRESS

2d. TRUSTEE EMAIL ADDRESS

VA FORM 29-336, XXX XXXX

Page 5

SECTION V - CERTIFICATION AND SIGNATURE
I Certify that I am the policyholder and I understand that:
1. My insurance will be paid according to the automatic survivorship clause as follows:
• If one or more principal beneficiary dies before me, the insurances will be divided between any remaining principal beneficiaries.
• If all principal beneficiaries die before me, the insurance will be paid to my contingent beneficiaries.
• If all principal and contingent beneficiaries die before me, the insurance will be paid based on the following order:
1) My surviving spouse,
2) My children and decedents of deceased children,
3) My parents or their surviving children (Veteran's Siblings),
4) The duly appointed executor or administrator of my estate,
5) Other next of kin based upon the laws of the Veteran's residence (domicile) at time of death.
2. This change cancels all prior beneficiary and option selections and applies to all Government Life Insurance policies.
3. For all programs other than VALife. If a designated principal beneficiary does not file a claim for payment within one year of the date of my death, then payment
may be made to the beneficiary(ies) next entitled. If no claim for payment is received from any designated beneficiary within two years of the date of my death, my
insurance will be paid in accordance with 38 U.S.C. 1917(f) or 38 U.S.C.
4. For VALife. If the designated beneficiary does not file a claim for the payment within one year of the date of my death, or if payment to the designated beneficiary
within that period is prohibited by Federal statute or regulation, my insurance will be paid based on the order of precedence listed in Item 1 of this section.
Beneficiaries listed under the order of precedence may file a claim for such payment during the one year period following the period as if the designated beneficiary
had predeceased the veteran.
IMPORTANT - The Veteran/Insured must sign and date the form. A VA Fiduciary, Power of Attorney or Court-Appointed Guardian cannot designate beneficiaries
for the Veteran/Insured. In such cases, a specific court order is required. Please contact our toll-free number at 1-800-669-8477 for more information on court order
requirements.
DATE SIGNED (MM/DD/YYYY)

SIGNATURE (Sign in ink)

NOTE: The section below should only be completed if the Veteran/Insured is competent but cannot sign their name. In such cases, the Veteran/ Insured must
make an "X" in the signature block and two impartial witnesses to the signature must sign below. An impartial witness cannot be someone named as a beneficiary on
this form.
PRINT NAME OF FIRST WITNESS (First-Middle Initial-Last)

PRINT NAME OF SECOND WITNESS (First-Middle Initial-Last)

MAILING ADDRESS (Number and street or rural route, P.O. Box, City, State, ZIP

MAILING ADDRESS (Number and street or rural route, P.O. Box, City, State, ZIP

TELEPHONE NUMBER (Include Area Code)

TELEPHONE NUMBER (Include Area Code)

SIGNATURE OF FIRST WITNESS (Sign in ink)

SIGNATURE OF SECOND WITNESS (Sign in ink)

DATE SIGNED (MM/DD/YYYY)

DATE SIGNED (MM/DD/YYYY)

Code and Country)

Code and Country)

THIS COMPLETED FORM MAY BE SUBMITTED BY:
Online Policy Access (OPA)

Document Upload

Mail

Using your online account, update your
designation securely at:
https://www.insurance.va.gov/home

Upload the form using our secure website
at:
https://insurance.va.gov/home/IDU

VARO & IC (B&O)
P. O. Box 8638
Philadelphia, PA 19101

VA FORM 29-336, XXX XXXX

Page 6