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Laborers International Union of North America National Guard District Council THE HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY MEMBER BENEFICIARY DESIGNATION CARD Insured Member s Name Last First MI LIUNA Local Death Benefits to be paid to the beneficiary ies named below Name Relationship The right to change beneficiary ies without the consent of said beneficiary ies is reserved. Signature of Insured Member Date For Office Use Only Policy Holder ...

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