Contingent Beneficiary Designation. If one or more of my primary beneficiaries dies before I die, I direct that any vested Awards under the Plan that are unpaid or unexercised at my death and that might otherwise have been paid to that beneficiary be: ___Allocated to my other named primary beneficiaries in proportion to the allocation given above (ignoring the interest allocated to the deceased primary beneficiary); or ___Allocated, in the proportion specified, among the following contingent beneficiaries: % to (Name) (Relationship) Address: % to (Name) (Relationship) Address: % to (Name) (Relationship) Address: % to (Name) (Relationship) Address:
Contingent Beneficiary Designation. If ❑ Primary or ❑ Contingent Beneficiary # , Name predeceases account holder(s), I (we) wish to have Beneficiary’s portion granted to the following Contingent Beneficiary:
Contingent Beneficiary Designation. Please list all contingent beneficiaries below. For each contingent beneficiary, please provide the number of the Primary Beneficiary above for which the contingent beneficiary is being designated. Percentage listed for contingent beneficiaries must total 100%. Date of birth is required for any beneficiary that is an individual. Tax ID is required for any beneficiary that is an entity. Custodian name is required for any beneficiary that is a minor. Contingent Beneficiary Designation. Enter Contingent Beneficiary #1 Name number of Primary Beneficiary for which this Contingent Beneficiary is being designated. Date of Birth/Trust Date Social Security Number/Tax ID % of Assets Address City State Zip Phone Number If beneficiary is a minor, provide the full name of the UTMA Custodian Contingent Beneficiary Designation. Enter Contingent Beneficiary #2 Name number of Primary Beneficiary for which this Contingent Beneficiary is being designated. Date of Birth/Trust Date Social Security Number/Tax ID % of Assets Address City State Zip Phone Number If beneficiary is a minor, provide the full name of the UTMA Custodian Contingent Beneficiary Designation. Enter Contingent Beneficiary #3 Name number of Primary Beneficiary for which this Contingent Beneficiary is being designated. Date of Birth/Trust Date Social Security Number/Tax ID % of Assets Address City State Zip Phone Number If beneficiary is a minor, provide the full name of the UTMA Custodian Contingent Beneficiary Designation. Enter Contingent Beneficiary #4 Name number of Primary Beneficiary for which this Contingent Beneficiary is being designated. Date of Birth/Trust Date Social Security Number/Tax ID % of Assets Address City State Zip Phone Number If beneficiary is a minor, provide the full name of the UTMA Custodian Contingent Beneficiary Designation. Enter Contingent Beneficiary #5 Name number of Primary Beneficiary for which this Contingent Beneficiary is being designated. Date of Birth/Trust Date Social Security Number/Tax ID % of Assets Address City State Zip Phone Number If beneficiary is a minor, provide the full name of the UTMA Custodian Contingent Beneficiary Designation. Enter Contingent Beneficiary #6 Name number of Primary Beneficiary for which this Contingent Beneficiary is being designated. Date of Birth/Trust Date Social Security Number/Tax ID % of Assets Address City State Zip Phone Number If beneficiary is a minor, provide the full name of the UTMA Custodian Contingent Beneficiaries - Per ...
Contingent Beneficiary Designation. If one or more of my Primary Beneficiaries dies before I die, I direct that any shares payable on my death under this Award Agreement that might otherwise have been paid to that Beneficiary: Be paid to my other named Primary Beneficiaries in proportion to the allocation given above (ignoring the interest allocated to the deceased Primary Beneficiary); or Be distributed among the following Contingent Beneficiaries. %to (Name) (Relationship) Address: %to (Name) (Relationship) Address: %to (Name) (Relationship) Address: Note: You are not required to name more than one Contingent Beneficiary but if you do, the sum of these percentages may not be larger than 100 percent. (Signature) (Date) (Print Name) (Address) RECEIVED BY: (Authorized Dominion Homes, Inc. representative) (Date)
Contingent Beneficiary Designation. If no Primary Beneficiary named above shall survive me, I designate such of the following person(s) who shall survive me as my Contingent Beneficiary(ies).
Contingent Beneficiary Designation. I hereby designate the following person(s) or entity(ies) as my contingent beneficiary , to whom payment of my remaining benefit under the Agreement at my death shall be made if no person or entity designated as primary beneficiary survives me or if all persons or entities designated as primary beneficiary die or cease to exist before payment in full of my benefit: Name, Relationship and Address SSN % of Benefit
Contingent Beneficiary Designation. If one or more of my primary beneficiaries dies before I die, I direct that any vested Awards under the Plan that are unpaid or unexercised at my death and that might otherwise have been paid to that beneficiary be: _____ Allocated to my other named primary beneficiaries in proportion to the allocation given above (ignoring the interest allocated to the deceased primary beneficiary); or _____ Allocated, in the proportion specified, among the following contingent beneficiaries: ______% to ___________________________________________________________________________ (Name) (Relationship) Address:_______________________________________________________________________________ ______% to ___________________________________________________________________________ (Name) (Relationship) Address:_______________________________________________________________________________ ______% to ___________________________________________________________________________ (Name) (Relationship) Address:_______________________________________________________________________________ Note: You are not required to name more than one contingent beneficiary but, if you do, the sum of these percentages may not be greater than 100 percent. ______________________________________ ___________________________ (Signature) (Date) ______________________________________ (Print Name) Please return an executed copy of this form to the following: Xxxxx Xxxxxxx, Vice President, Human Resources Manager, Rurban Financial Corp., 000 Xxxxxxx Xxxxxx, Xxxxxxxx, Xxxx 00000.
Contingent Beneficiary Designation. If one or more of my primary beneficiaries dies before I die, I direct that any vested Awards under the Plan that are unpaid or unexercised at my death and that might otherwise have been paid to that beneficiary be: ¨ Allocated to my other named primary beneficiaries in proportion to the allocation given above (ignoring the interest allocated to the deceased primary beneficiary); or ¨ Allocated, in the proportion specified, among the following contingent beneficiaries: % to (Name) (Relationship) Address: % to (Name) (Relationship) Address: % to (Name) (Relationship) Address: Note: You are not required to name more than one contingent beneficiary but, if you do, the sum of these percentages may not be greater than 100 percent. (Signature) (Date) (Print Name) Please return an executed copy of this form to the following: Lxxxx Xxxxxxx, Vice President, Human Resources Manager, Rurban Financial Corp., 400 Xxxxxxx Xxxxxx, Xxxxxxxx, Xxxx 00000.
Contingent Beneficiary Designation. Total Contingent Beneficiary Share % must equal 100% Full name (Last, First, Middle Initial): Relationship: Date of birth: Address (Street, City, State, Zip): Percentage: Full name (Last, First, Middle Initial): Relationship: Date of birth: Address (Street, City, State, Zip): Percentage: The person(s) to receive, if living, the amount standing to my credit in the Members Annuity Reserve Account of the County Employees Retirement System in the event of my death before retirement, or to receive the Death Benefit if applicable. Name of Member (Employee) Date of Birth Sex Mailing Address (Street, City, Zip) Social Security Number Signature of Member (Employee) Date Signature of Witness Date
Contingent Beneficiary Designation. If none of the above-named Primary Beneficiaries survives me, the Shares distributable to me under the Agreement shall be paid, in equal portions unless otherwise indicated, to the following Contingent Beneficiary(ies) then surviving: Name Relationship Date of Birth Social Security No. Percentage (Signature) Date Date (Print Name)
