Beneficiary Form - Frugal Empowerment Foundation

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Beneficiary,s Legal Name

First

Last

Date of Birth

Phone

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Beneficiary's Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Project Name (Please select)

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Witness's Legal Name

First

Last

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Signature

Phone

Consent

I affirm that the policy holder has reviewed and consented to the beneficiary designation.

Date