401(k) Beneficiary Designation IMPORTANT INFORMATION ABOUT THIS FORM If you choose to name more than two Primary and/or Contingent Beneficiary(ies), please upload a separate sheet of paper with your additional designations. You must also sign and date the additional sheet of paper. If you are married and designate additional primary beneficiaries, your spouse's certification must be notarized by a Notary Public or witnessed by a Plan Representative. Therefore, you cannot complete this form online. Please download the form here. This information in this form will be retained by the Plan Administrator and does not need to be submitted to John Hancock. PARTICIPANT INFORMATION Name as displayed on your Social Security Card. First Name Mid Init Last Name Social Security Number Address Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Phone No. Date of Birth Marital Status: Married Not Married or Widowed Divorced 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. Full Name (Last Name, First Name, Initial) Soc Sec Number Percentage % Relationship Spouse Child Parent Sibling Other Relationship Date of Birth Address, City, State, Zip Code, Country Add Remove 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. Full Name (Last Name, First Name, Initial) Soc Sec Number Percentage % Relationship Spouse Child Parent Sibling Other Relationship Date of Birth Address, City, State, Zip Code, Country Add Remove SIGNATURE Signature of Particpant Clear Full Name Date Submit