Person(s) as a Primary Designation. (Please indicate the percentage for each beneficiary.) Name___________________________________ Relationship___________________ / _______% Address:_______________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ Relationship___________________ / _______% Address:_______________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ Relationship___________________ / _______% Address:_______________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ Relationship___________________ / _______% Address:_______________________________________________________________________ (Street) (City) (State) (Zip)
Appears in 3 contracts
Samples: Executive Supplemental Compensation Agreement (Pacific Financial Corp), Executive Supplemental Compensation Agreement (Pacific Financial Corp), Executive Supplemental Compensation Agreement (Pacific Financial Corp)
Person(s) as a Primary Designation. (Please indicate the percentage for each beneficiary.) Name___________________________________ Relationship___________________ / _______% Address:_________________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ Relationship___________________ / _______% Address:_______________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ Relationship___________________ / _______% Address:_______________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ Relationship___________________ / _______% Address:_________________________________________________________________________ (Street) (City) (State) (Zip)
Appears in 2 contracts
Samples: Supplemental Executive Retirement Plan (North Bay Bancorp/Ca), Supplemental Executive Retirement Plan (Venture Financial Group Inc)
Person(s) as a Primary Designation. (Please indicate the percentage for each beneficiary.) Name___________________________________ Relationship___________________ / _______% Relationship__________________/__________% Address:_______________________________________________________________________ (StreetState) (City) (State) (ZipState)(Zip) Name___________________________________ Relationship___________________ / _______% Relationship__________________/__________% Address:_______________________________________________________________________ (StreetState) (City) (State) (ZipState)(Zip) Name___________________________________ Relationship___________________ / _______% Relationship__________________/__________% Address:_______________________________________________________________________ (StreetState) (City) (State) (ZipState)(Zip) Name___________________________________ Relationship___________________ / _______% Relationship__________________/__________% Address:_______________________________________________________________________ (StreetState) (City) (State) (ZipState)(Zip)
Appears in 2 contracts
Samples: Endorsement Method Split Dollar Plan Agreement (Heritage Commerce Corp), Endorsement Method Split Dollar Plan Agreement (Heritage Commerce Corp)
Person(s) as a Primary Designation. (Please indicate the percentage for each beneficiary.) Name___________________________________ RelationshipRelationship ___________________ / _______% Address:_______________________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ RelationshipRelationship ___________________ / _/_______% Address:_______% Address:________________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ RelationshipRelationship ___________________ / ________ % Address:: _______________________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ RelationshipRelationship ___________________ / _______% Address:_______________________________________________________________________________ (Street) (City) (State) (Zip)
Appears in 2 contracts
Samples: Split Dollar Life Insurance Agreement (Venture Financial Group Inc), Participation Agreement (Venture Financial Group Inc)
Person(s) as a Primary Designation. (Please indicate the percentage for each beneficiary.) Name___________________________________ Relationship___________________ / _______% Address:_________________________________________________________________________ (Street) (City) (State) (ZipState)(Zip) Name___________________________________ Relationship___________________ / _______% Address:_________________________________________________________________________ (Street) (City) (State) (ZipState)(Zip) Name___________________________________ Relationship___________________ / _______% Address:_________________________________________________________________________ (Street) (City) (State) (ZipState)(Zip) Name___________________________________ Relationship___________________ / _______% Address:_________________________________________________________________________ (Street) (City) (State) (ZipState)(Zip)
Appears in 1 contract
Samples: Supplemental Compensation Agreement (Columbia Banking System Inc)
Person(s) as a Primary Designation. (Please indicate the percentage for each beneficiary.) NameName _______________________________________________________________________________________ RelationshipRelationship ___________________ / _______% Address:: __________________________________________________________________________________________________________________________________ (Street) (City) (State) (Zip) NameName _______________________________________________________________________________________ RelationshipRelationship ___________________ / _______% Address:: __________________________________________________________________________________________________________________________________ (Street) (City) (State) (Zip) NameName _______________________________________________________________________________________ RelationshipRelationship ___________________ / _______% Address:: __________________________________________________________________________________________________________________________________ (Street) (City) (State) (Zip) NameName _______________________________________________________________________________________ RelationshipRelationship ___________________ / _______% Address:: __________________________________________________________________________________________________________________________________ (Street) (City) (State) (Zip)
Appears in 1 contract
Samples: Supplemental Compensation Agreement (Columbia Banking System Inc)
Person(s) as a Primary Designation. (Please indicate the percentage for each beneficiaryBeneficiary.) Name___________________________________ Relationship___________________ / _______% Address:_________________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ Relationship___________________ / _______% Address:_________________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ Relationship___________________ / _______% Address:_________________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ Relationship___________________ / _______% Address:_________________________________________________________________________ (Street) (City) (State) (Zip)
Appears in 1 contract
Samples: Split Dollar Agreement (Heritage Financial Corp /Wa/)
Person(s) as a Primary Designation. (Please indicate the percentage for each beneficiary.) Name___________________________________ Relationship___________________ / _______% Address:_________________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ Relationship___________________ / _______% Address:_________________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ Relationship___________________ / _______% Address:_________________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ Relationship___________________ / _______% Address:_________________________________________________________________________ (Street) (City) (State) (Zip)
Appears in 1 contract
Samples: Executive Supplemental Compensation Agreement (Pacific Financial Corp)
Person(s) as a Primary Designation. (Please indicate the percentage for each beneficiary.) Name________________)
1. Name:___________________Relationship:___________________SS#:___________________%___________________ Relationship___________________ / _______% Address:_______________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ Relationship___________________ / _______% Address:_______________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ Relationship___________________ / _______% Address:_______________________________________________________________________ (Street) (City) (State) (Zip) Name___________________________________ Relationship___________________ / _______% Address:_______________________________________________________________________ (Street) (City) (State) (Zip)
2. Name:___________________Relationship:___________________SS#:___________________%____________________ Address:____________________________________________________________________________________________ (Street) (City) (State) (Zip)
3. Name:___________________Relationship:___________________SS#:___________________%___________________ Address:____________________________________________________________________________________________ (Street) (City) (State) (Zip)
4. Name:___________________Relationship:___________________SS#:___________________%___________________ Address:____________________________________________________________________________________________ (Street) (City) (State) (Zip)
Appears in 1 contract
Samples: Executive Salary Continuation Plan (Origin Bancorp, Inc.)