PRIMARY BENEFICIARY DESIGNATION INFORMATION
- If I am married and have not designated my spouse as my sole primary beneficiary, this designation of beneficiary will not be effective unless consented to by my spouse. If this is the case, you may download the form here.
- If I am not married on the date I sign this Beneficiary Designation Form, but subsequently become married prior to benefit commencement, I understand that this designation of beneficiary shall cease to be effective upon my marriage.
- I hereby agree to notify the Plan Administrator in writing in the event my marital status changes.
I hereby designate as my beneficiary the person(s) listed below who survive me. If more than one person is listed, benefits shall be divided according to the percentages indicated. I understand that if I designate more than one beneficiary below, the percentages MUST add up to 100%. If more than one person is listed and no percentages are indicated, or the percentages do not add up to 100%, benefits shall be paid in equal shares to my primary beneficiary(ies) who survive me. If a percentage is indicated and a primary beneficiary(ies) does not survive me, the percentage of that beneficiary's shares shall be divided among the surviving primary beneficiary(ies) in proportion to the percentages shown for such beneficiary(ies) below.
PRIMARY BENEFICARY DESIGNATION
YOU CAN NAME TWO BENEFICIARIES HERE.
IF YOU HAVE ADDITIONAL BENEFICIARIES, PLEASE UPLOAD A SEPARATE SHEET OF PAPER, SIGNED AND DATED, WITH YOUR ADDITIONAL DESIGNATIONS.
CONTINGENT BENEFICARY DESIGNATION
If no primary beneficiary listed above survives me, I hereby designate as my beneficiary the person or persons listed below who survive me. I understand that if I designate more than one beneficiary below, the percentages must add up to 100%. Payment to secondary beneficiaries will be made according to the rules of succession described for Primary Beneficiary.