American Century Life Insurance Company

Change of Assignment


Name of Insured                                                                                                                      

Policy Number                                                                                                                         

Date                                                                                                                                      

I request to change the current irrevocable assignment of benefits to:


Old Assignee                                                                                                                           

Address                                                                                                                                  

City, State and Zip                                                                                                                   

Phone Number                                                                                                                        


New Assignee                                                                                                                         

Address                                                                                                                                  

City, State and Zip                                                                                                                   

Phone Number                                                                                                                        


Date                                                                                                                                      


Signature