BENEFICIARY OR ALTERNATE PAYEE INFORMATION (IF APPLICABLE Sample Clauses

BENEFICIARY OR ALTERNATE PAYEE INFORMATION (IF APPLICABLE. Check here if you are the surviving spouse or other beneficiary for the Former Participant and the Former Participant is deceased. Documentation must be provided showing current authority of the representative to file on behalf of the deceased. Please complete the information below and then continue on to Parts 4 and 5 on the next page. Check here if you are an alternate payee under a qualified domestic relations order (QDRO). The Settlement Administrator may contact you with further instructions. Please complete the information below and then continue on to Parts 4 and 5 on the next page. Your First Name Middle Last Name Your Social Security Number or Tax ID Number Your Date of Birth Your Mailing Address City, State, ZIP M M D D Y Y Y Y PART 4: PAYMENT ELECTION Payment to Self – A check subject to mandatory federal and applicable state withholding tax will be mailed to your address on the previous page. Direct Rollover to an Eligible Plan – Check only one box below and complete the Rollover Information Section below: Government 457(b) 401(a)/401(k) 403(b) Direct Rollover to a Traditional IRA Direct Rollover to a Xxxx XXX (subject to ordinary income tax) Rollover Information: Company or Trustee’s Name (to whom the check should be made payable) Company or Trustee’s Mailing Address 1 Company or Trustee’s Mailing Address 2 Company or Trustee’s City State Zip Code Your Account Number Company or Trustee’s Phone Number PART 5: SIGNATURE, CONSENT, AND SUBSTITUTE IRS FORM W-9 UNDER PENALTIES OF PERJURY UNDER THE LAWS OF THE UNITED STATES OF AMERICA, I CERTIFY THAT ALL OF THE INFORMATION PROVIDED ON THIS FORMER PARTICIPANT CLAIM FORM IS TRUE, CORRECT, AND COMPLETE AND THAT I SIGNED THIS FORMER PARTICIPANT CLAIM FORM.
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BENEFICIARY OR ALTERNATE PAYEE INFORMATION (IF APPLICABLE. Check here if you are the surviving spouse or other beneficiary for the Former Participant and the Former Participant is deceased. Documentation must be provided showing current authority of the representative to file on behalf of the deceased. Please complete the information below and then continue on to Parts 4 and 5 on the next page. Check here if you are an alternate payee under a qualified domestic relations order (QDRO), or attorney-in-fact for the Former Participant. The Settlement Administrator may contact you with further instructions. Please complete the information below and then continue on to Parts 4 and 5 on the next page. Your First Name Middle Last Name Your Social Security Number or Tax ID Number Your Date of Birth Your Mailing Address M X X X X X X X Xxxx Xxxxx Zip Code
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BENEFICIARY OR ALTERNATE PAYEE INFORMATION (IF APPLICABLE. Check here if you are the surviving spouse or other beneficiary for the Former Participant Class Member and the Former Participant Class Member is deceased. Documentation must be provided showing current authority of the representative to file on behalf of the deceased. Please complete the information below and then continue on to Parts 4 and 5 on the next page. Check here if you are an alternate payee under a qualified domestic relations order (QDRO). The Settlement Administrator may contact you with further instructions. Please complete the information below and then continue on to Parts 4 and 5 on the next page. [FORMER PARTICIPANT ROLLOVER FORM CONTINUES ON THE NEXT PAGE] PART 4: PAYMENT ELECTION Direct Rollover to an Eligible Plan – Check only one box below and complete the Rollover Information Section below: Government 457(b) Direct Rollover to a Traditional IRA Rollover Information: 401(a)/401(k) Direct Rollover to a Xxxx XXX (subject to ordinary income tax) 403(b) Company or Trustee’s Name (to whom the check should be made payable)
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Related to BENEFICIARY OR ALTERNATE PAYEE INFORMATION (IF APPLICABLE

  • Alternate Payee A. Pursuant to the provisions of the Assumption of Liability Endorsement, the Reinsurer has agreed that, in lieu of payment to the Company or its receiver, rehabilitator, liquidator, conservator, or other statutory successor, it shall pay valid claims under the Policy directly to the Insured, at the Insured's request, if a Cut Through Triggering Event (as that term is defined in the Assumption of Liability Endorsement) occurs.

  • How do the RMD Rules Impact my Designated Beneficiary or Beneficiaries The RMD rules provide for the determination of your designated beneficiary or beneficiaries as of September 30 of the year following your death. Consequently, any beneficiary may be eliminated for purposes of calculating the RMD by the distribution of that beneficiary’s benefit, through a valid disclaimer between your death and the end of September following the year of your death, or by dividing your IRA account into separate accounts for each of several designated beneficiaries you may have designated.

  • Beneficiary Rollovers from Employer-Sponsored Retirement Plans If you are a spouse Beneficiary, nonspouse Beneficiary, or the trustee of an eligible type of trust named as Beneficiary of a deceased employer plan participant, you may directly roll over inherited assets from a qualified retirement plan, 403(a) annuity, 403(b) tax-sheltered annuity, or 457(b) governmental deferred compensation plan to an inherited IRA. The IRA must be maintained as an inherited IRA, subject to the beneficiary distribution requirements.

  • Multiple Individual Retirement Accounts In the event the depositor maintains more than one Individual Retirement Account (as defined in Section 408(a)) and elects to satisfy his or her minimum distribution requirements described in Article IV above by making a distribution from another individual retirement account in accordance with Item 6 thereof, the depositor shall be deemed to have elected to calculate the amount of his or her minimum distribution under this custodial account in the same manner as under the Individual Retirement Account from which the distribution is made.

  • Beneficiary The Participant may file with the Committee a written designation of a beneficiary on such form as may be prescribed by the Committee and may, from time to time, amend or revoke such designation.

  • STATEWIDE PAYEE DESK Contractor represents and warrants that it is registered with the Statewide Payee Desk, which registration is a condition to payment.

  • Designation of Beneficiary The depositor may designate a beneficiary or beneficiaries to receive benefits from the custodial account in the event of the depositor’s death. In the event the depositor has not designated a beneficiary, or if all beneficiaries shall predecease the depositor, the following persons shall take in the order named:

  • Traditional Individual Retirement Custodial Account The following constitutes an agreement establishing an Individual Retirement Account (under Section 408(a) of the Internal Revenue Code) between the depositor and the Custodian.

  • SIMPLE Individual Retirement Custodial Account (Under section 408(p) of the Internal Revenue Code) The participant named above is establishing a savings incentive match plan for employees of small employers individual retirement account (SIMPLE IRA) under sections 408(a) and 408(p) to provide for his or her retirement and for the support of his or her beneficiaries after death. The custodian named above has given the participant the disclosure statement required by Regulations section 1.408-6. The participant and the custodian make the following agreement:

  • Domestic Partners; Spouses; Gender Discrimination If the Contract Amount is $100,000 or more, Contractor certifies that it is in compliance with PCC 10295.3, which places limitations on contracts with contractors who discriminate in the provision of benefits regarding marital or domestic partner status.

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