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COMPLETING A BENEFICIARY CHANGE FORM

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					COMPLETING A BENEFICIARY
IMPORTANT INSTRUCTIONS FOR



CHANGE FORM
                                                                                                    Allstate Life Insurance Company
                                                                                            P.O. Box 94036, Palatine, IL 60094-4036
                                                                                                              Phone: 1-800-390-1277
                                                                                                                FAX: 1-866-487-8538
THIS FORM NOT TO BE USED WITH SECTION 401 ANNUITIES

PLEASE READ CAREFULLY!
It is important to you as owner of the policy — and to us — that your instructions be carried out concerning the payment
of proceeds that become due.

Please take some time to carefully read the following important instructions. Your Allstate Life Insurance Company
(“Allstate”) policy explains how you, as owner, may change the beneficiary designation and when such a change will
become effective.

As explained in your policy (or policies), the “primary” beneficiary (also called “payee” or “first class” beneficiary) is the
person(s) or legal entity, such as a trust or estate, who would be entitled to receive the proceeds. The “contingent”
beneficiary (also called “second class” beneficiary) is the person(s) or legal entity who would receive the proceeds in the
event the primary beneficiary could not.

Payment of proceeds to any beneficiary is subject to the interest of any assignee.

In the event a trust is named as beneficiary, Allstate shall not need to inquire into the terms of the trust and shall not need
to know its terms. Payment to the named trust shall fully discharge Allstate of all liability to the extent of such payment.

If your policy requires that a change of beneficiary be endorsed, the parties hereby agree that execution of this change of
beneficiary form shall permit the change without endorsement.

If you cannot sign this form other than by making your mark (X), your execution of the form shall be notarized.

Availability of separate beneficiary designations will vary by product purchased. For annuities, the beneficiary may be
determined by the contract requirements.

We suggest you review the sample beneficiary designations and then complete the Request for Change of Beneficiary
form to fit your exact needs. For answers to your questions or for additional assistance, call your financial representative
or a customer service representative. You may also wish to discuss this with your attorney or tax advisor.

Divorce: If the change in beneficiary designation is being made as the result of a divorce, we suggest that you review the
divorce decree and/or property settlement agreement with your attorney to ensure that the intended beneficiary change
does not conflict with any provisions in the decree or property settlement agreement. Please be aware that a divorce in
some states may result in the automatic revocation of a spouse as beneficiary.

Uniform Transfers to Minors Act: If naming a minor as beneficiary, payment may be made to an adult custodian for the
use and benefit of the child(ren) under a state’s Uniform Transfers to Minors Act (UTMA) - or Uniform Gifts to Minors Act
(in South Carolina and Vermont). By naming a custodian for minor children, payment may be expedited and may eliminate
the need for a court-appointed guardian of the property of the children. If a Custodian is named in the UTMA designation
under Step 4 but no State is designated, Illinois UTMA will be used, as it is Allstate’s home office location.




FICCA77PUT                                                                                                                 (02/05)
THE POLICY OWNER SHOULD FOLLOW THE STEPS BELOW:
Step 1:      Fill in all the required information, using a separate form for each policy on which a change is requested. Any
             incomplete information will delay processing.

Step 2:      Complete the primary (first class) beneficiary section by printing or typing all the requested information. If
             additional space is needed, please use a separate sheet of paper and attach it to the Request for Change of
             Beneficiary form. If naming a trust as primary beneficiary, fill in the trust information under the appropriate trust
             section provided on the form.

             Provide the full name (first name, middle initial and last name), address, relationship, and the date of birth of
             each named beneficiary. Provide the full given name, e.g., “Mary S. Doe,” not “Mrs. John A. Doe”.

             Note: Unless you specify otherwise, if there is more than one primary beneficiary named, each
             such person will receive equal shares. Please use percentages (%). Do not use dollar amounts.

Step 3:      Complete the contingent (second class) beneficiary section by printing or typing all the requested information.
             The contingent beneficiary is the person(s) who would receive the proceeds if the
             primary beneficiary(ies) could not. If no contingent beneficiary is designated, and if we are unable
             to pay the primary beneficiary (because, for example, the primary beneficiary died before the
             insured under a life policy), the proceeds will be paid as outlined in the policy.

             If you are only making a change to the contingent beneficiary, please “re-name” the primary
             beneficiary because acceptance of the change by Allstate Life Insurance Company cancels all
             prior designations.

             Note: Unless you specify otherwise, if there is more than one contingent beneficiary named, each such
             person will receive equal shares. Please use percentages (%). Do not use dollar amounts.

Step 4:      If you designate a minor beneficiary in Step 2 or Step 3 above, you should consider designating an
             adult custodian to receive the proceeds on behalf of the child should payment come due while the child is still
             a minor. Allstate Life Insurance Company will pay the custodian for the benefit of the child under the Uniform
             Transfers to Minors Act law of the state designated or Illinois if a custodian is named but no state is designated.

Step 5:      Complete U.S. Citizen Section

Step 6:      The policy owner must sign and date the request. You should also list your address so we may
             send you a confirmation that the change has been accepted. Also, please provide a phone number where we
             can contact you if we need to obtain or clarify information.

Step 7:      Mail the completed, dated and signed form to:

                 Allstate Life Insurance Company
                 P. O. Box 94036
                 Palatine, IL 60094-4036

You may also present the completed form to your financial representative who will forward the form for you to Allstate Life
Insurance Company for approval. The requested change in the beneficiary designation will not become effective until and
unless it is accepted, in writing, by a representative at Allstate’s home office.

Once we approve the request, we will send confirmation, which you should keep with your Allstate Life Insurance Company
policy or other important papers.




FICCA77PUT                                                                                                                 (02/05)
SAMPLE BENEFICIARY DESIGNATIONS
Reminder: Please review the instruction page for additional information and steps.

1. All Beneficiaries:
       Primary Beneficiary:               Joan A. Smith ................................................Relationship: spouse ..........100%
                                          Date of Birth: 1/1/1971
                                          Address: 306 Main Street, Townville, USA 00011
                                          Taxpayer Identification # (Social Security #): 123-45-6789

2. One Primary Beneficiary and one Contingent Beneficiarary:
       Primary Beneficiary:               Joan A. Smith ................................................Relationship: spouse ..........100%

       Contingent Beneficiary:            William B. Smith ............................................Relationship: father ............100%

3. Two Primary Beneficiaries in UNEQUAL amounts:
       Primary Beneficiary:               Joan A. Smith ................................................Relationship: spouse ..........75%
                                          William B. Smith ............................................Relationship: father ............25%

4. A Living Trust as Primary Beneficiary (specify name and date of trust):
       Primary Beneficiary:       Joseph C. Smith Living Trust Dated October 14, 1994 ..............................100%
                                  John D. Smith, Trustee
   Note: Do not send us a copy of the trust document.

5. A Creditor, as their interest appears, as Primary Beneficiary with balance of proceeds to spouse:
       Primary Beneficiaries: ABC Mortgage Corp., Creditor, as their interest appears;
       and Joan A. Smith, spouse, balance of proceeds ..................................................................................100%

6. A minor child (children) as Contingent Beneficiary with nominated Custodian:
       Primary Beneficiary:               Joan A. Smith ................................................Relationship: spouse ..........100%

       Contingent Beneficiaries:          Michael E. Smith............................................Relationship: son ................50%
                                          Susan F. Smith ..............................................Relationship: daughter........50%

   I designate Thomas G. Smith, 306 Main Street, Townville, USA, 00011, Social Security Number 999-99-9999, as
   Custodian of the funds payable to each minor child named above, under the [Illinois] Uniform Transfers to Minors Act.

7. A born and unborn child (children) as contingent beneficiaries:
       A born and unborn child (children) as Contingent Beneficiaries:
       Primary Beneficiary:        Joan A. Smith ................................................Relationship: spouse ..........100%

       Contingent Beneficiary:            Michael E. Smith, son, and those children presently unknown
                                          who are born to or adopted by Joseph C. Smith after 9/1/2004.

   Note: List information for those children presently known (Name, address, social security number, etc.), then state

   “and those children presently unknown who are born to or adopted by______________________________ [name]

   after ___________________ [date of Request for Change of Beneficiary].”




FICCA77PUT                                                                                                                                     (02/05)
                 BENEFICIARY (PAYEE)
CHANGE OFBE USED WITH SECTION 401 ANNUITIES
REQUEST FOR


THIS FORM NOT TO                                                                                             Allstate Life Insurance Company
                                                                                                    P.O. Box 94036, Palatine, IL 60094-4036
Use ball point pen when completing form                                                         Phone: 1-800-390-1277 FAX: 1-866-487-8538

STEP 1 - Contract/Policy Information (ALL FIELDS MUST BE COMPLETED). Only one policy number and
         Insured/Annuitant per change form. Submit a separate change of beneficiary form for each policy.


Owner’s Name                                                      Owner’s SSN/TIN                       Contract/Policy #

Joint Owner’s Name (if applicable)                                                                      Joint Owner’s SSN/TIN

Insured or Annuitant’s Name (if applicable)                                                             Insured or Annuitant’s SSN/TIN

STEP 2 - Primary Beneficiary (ies) – If more than 2 Primary Beneficiaries, please use a separate sheet of paper and
         attach to this form, and be sure to specify what percentage of the payment each beneficiary should receive
A. Individual, Corporation or Estate

Name of Primary Beneficiary #1                                        Name of Primary Beneficiary #2

Street Address                                                        Street Address

City/State/Zip                                                        City/State/Zip
                                                              %                                                                           %
SSN/TIN                                             Percent           SSN/TIN                                                   Percent

Date of Birth/Trust                                                   Date of Birth/Trust

Relationship                                                          Relationship

B. Trust as Primary Beneficiary (NOT Under Last Will)

Name and Date of Trust

Name of Current Trustee                                                   Trust Tax ID Number

Street Address                                                            City                                   State              Zip
C. Trust as Primary Beneficiary (Trust Within Last Will)
To the trustee of the trust created pursuant to the Last Will and Testament of ____________________________ as admitted
                                                                                                 Name
to probate provided the trustee submits a written claim within six months of the death of the person that triggered payment
under the policy. If no such claim is made by the trustee, the proceeds shall be paid to _______________________________.
                                                                                                                 Name
STEP 3 - Contingent Beneficiary(ies) – If more than 2 Contingent Beneficiaries, please use a separate sheet of
         paper & attach to this form. Specify what percentage of the payment each beneficiary should receive


Name of Contingent Beneficiary #1                                     Name of Contingent Beneficiary #2

Street Address                                                        Street Address

City/State/Zip                                                        City/State/Zip
                                                              %                                                                           %
SSN/TIN                                             Percent           SSN/TIN                                                   Percent

Date of Birth/Trust                                                   Date of Birth/Trust

Relationship                                                          Relationship


          For Home Office Use Only

FICCA77PUT                                                                                                                               (02/05)
STEP 4 - Important Note for Minor Children Designated above:
Proceeds cannot be paid directly to a minor beneficiary. Proceeds can, however, be paid to an adult custodian for such minor
beneficiary designated by the owner under the relevant state Uniform Transfers to Minors Act. (See instructions)

I designate
                                         Name                                                             Custodian’s SSN/TIN (REQUIRED)


            Street Address                                               City                                       State          Zip

as Custodian of the funds payable to each minor child, under the ______________________ Uniform Transfers
                                                                                      Name of State
to Minors Act (or Uniform Gifts to Minors Act if SC or VT is designated). NOTE: If a custodian is named but no

state-specific Uniform Transfers to Minors Act is designated, Allstate will use the provisions of Illinois UTMA.

STEP 5 - Citizenship - If more than 2 non-U.S. Citizens, please complete and attach separate sheet of paper

Are all Beneficiaries, Custodians and/or Trustees U.S. Citizens?                Yes         No. If No, complete below.


Name                                                                 Name

Party to the Contract (i.e. “Trustee”)                               Party to the Contract (i.e. “Trustee”)

Country of Citizenship                                               Country of Citizenship

Permanent Resident Card Number (Attach Copy if Possible)             Permanent Resident Card Number (Attach Copy if Possible)

Visa Number and Type (Attach Copy if Possible)                       Visa Number and Type (Attach Copy if Possible)


STEP 6 - Signatures

                   BY THIS REQUEST I HEREBY CANCEL ALL PRIOR BENEFICIARY (PAYEE)
                      DESIGNATIONS AND SETTLEMENT PROVISIONS ON THIS POLICY.
NOTICE TO ALL PARTIES COMPLETING THIS FORM: It is fraudulent to fill out this form with information you
know to be false or knowingly omit important facts. Criminal and/or civil penalties may result from such acts.
                  This change is subject to the provisions and limitations found in the policy.

X                                                                        X
Signature of Policy Owner                                                Signature of Joint Owner (if Applicable)


Owner’s Street Address                                                   City                                       State          Zip


Date Signed                                                              Signed at: City                            State


STEP 7 - Submission Instructions
Mail completed, signed and dated form to:                  ALLSTATE LIFE INSURANCE COMPANY
                                                           PO BOX 94036
                                                           Palatine, IL 60094-4036


HOME OFFICE ENDORSEMENT - FOR ALLSTATE LIFE INSURANCE COMPANY USE ONLY


Recorded at Allstate Life’s Home Office:                   X
                                                                Home Office Authorization                                          Date



          For Home Office Use Only
FICCA77PUT                                                                                                                           (02/05)

				
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