ANOA Accidental Death Plan Beneficiary Information

 

Alabama Narcotic Officers Association

ACCIDENTAL DEATH PLAN BENEFICIARY INFORMATION

 

 MEMBER INFORMATION

 

LAST NAME:  ______________________________ FIRST NAME: _____________________________

 

CONTACT ADDRESS: ________________________________________________________________

 

___________________________________________________________________________________

 

PHONE: (________)______________________________________________________

 

AGENCY: ______________________________________________________________

 

EMAIL ADDRESS: _______________________________________________________

 

CONTACT IN CASE OF DEATH: ___________________________________________________

 

RELATIONSHIP: _________________________________________________________________ 

 

PHONE: (________)________________________________________________________________

 

BENEFICIARY INFORMATION

 

(If requesting other beneficiary)

 

 

 

LAST NAME: _____________________________ FIRST NAME: ______________________________

 

CONTACT PHONE: (________)__________________________________________

 

RELATIONSHIP: _________________________________________________________________ 

 

Without a designation, benefits are paid in the following order: member’s spouse if living.  If not, equally to living children; if none, equally to living parents; if none, equally to living brothers and sisters; if none, to the estate.

 

ANOA
P.O. Box 1010
Auburn, AL 36831-1010