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Pact Forms_ Successor Owner Form Template

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					                     Successor Account Owner Form
PACT now allows the Purchaser to designate a Successor Account Owner. The
Successor Account Owner is the individual you name to become the Purchaser and
assume ownership of the contract upon your death. If you wish to authorize a Successor
Account Owner on your account, please fill out this form, have it notarized, and mail to:

       PACT Program
       P.O. Box 12865
       Birmingham, AL 35202-2865

Successor Account Owner’s Name:

Successor Account Owner’s Signature:

Address:


Home Phone Number:

Work Phone Number:

Social Security Number:

E-mail Address:


PACT Account Number(s):

Purchaser’s Name:


___________________________________________                          ________________
Purchaser’s Signature (Requires Notary)                              Date


                                         STATE OF ALABAMA
                                         COUNTY OF
                                         THE FOREGOING INSTRUMENT WAS
                                         ACKNOWLEDGED BEFORE ME THIS
                                                 DAY OF                      , 20

                                           NOTARY PUBLIC, STATE OF ALABAMA

				
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posted:4/9/2008
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