Trust as a Primary Designation. Name of the Trust: Execution Date of the Trust: / / Name of the Trustee: Beneficiary(ies) of the Trust (please indicate the percentage for each beneficiary): Is this an Irrevocable Life Insurance Trust? Yes No (If yes and this designation is for a Split Dollar agreement, an Assignment of Rights form should be completed.)
Appears in 11 contracts
Samples: Director Supplemental Retirement Plan (South Street Financial Corp), Executive Supplemental Retirement Plan Agreement (South Street Financial Corp), Director Deferral Plan Agreement (South Street Financial Corp)
Trust as a Primary Designation. Name of the Trust: Execution Date of the Trust: / / Name of the Trustee: Beneficiary(ies) of the Trust Trust: (please indicate the percentage for each beneficiary): Name(s): Name(s): Is this an Irrevocable Life Insurance Trust? ¨ Yes ¨ No (If yes and this designation is for a Split Dollar agreementJoint Beneficiary Agreement, an Assignment of Rights form should must be completed.)
Appears in 5 contracts
Samples: Executive Salary Continuation Agreement (Peoples Bancorp of North Carolina Inc), Executive Salary Continuation Agreement (Peoples Bancorp of North Carolina Inc), Executive Salary Continuation Agreement (Peoples Bancorp of North Carolina Inc)
Trust as a Primary Designation. Name of the Trust: Execution Date of the Trust: / / Name of the Trustee: Beneficiary(ies) of the Trust (please indicate the percentage for each beneficiaryTrust: Name(s): Name(s): Is this an Irrevocable Life Insurance Trust? o Yes o No (If yes and this designation is for a Split Dollar agreementJoint Beneficiary Designation Agreement, an Assignment of Rights form should must be completed.)
Appears in 2 contracts
Samples: Executive Salary Continuation Agreement (Centra Financial Holdings Inc), Executive Salary Continuation Agreement (Centra Financial Holdings Inc)
Trust as a Primary Designation. Name of the Trust: Execution Date of the Trust: / / Name of the Trustee: Beneficiary(ies) Beneficiary of the Trust Trust: (please indicate the percentage for each beneficiary): Name(s): Name(s): Is this an Irrevocable Life Insurance Trust? □ Yes □ No (If yes and this designation is for a Split Dollar agreementJoint Beneficiary Designation Agreement, an Assignment of Rights form should must be completed.)
Appears in 2 contracts
Samples: Officer Salary Continuation Agreement (Southcrest Financial Group Inc), Joint Beneficiary Designation Agreement (Southcrest Financial Group Inc)
Trust as a Primary Designation. Name of the Trust: Execution Date of the Trust: / / Name of the Trustee: Beneficiary(ies) Beneficiary of the Trust Trust: (please indicate the percentage for each beneficiary): Name(s): Name(s): Is this an Irrevocable Life Insurance Trust? ¨ Yes ¨ No (If yes and this designation is for a Split Dollar agreementJoint Beneficiary Designation Agreement, an Assignment of Rights form should must be completed.)
Appears in 2 contracts
Samples: Executive Salary Continuation Agreement (New Hampshire Thrift Bancshares Inc), Executive Salary Continuation Agreement (New Hampshire Thrift Bancshares Inc)
Trust as a Primary Designation. Name of the Trust: Execution Date of the Trust: / / Name of the Trustee: Beneficiary(ies) of the Trust (please indicate the percentage for each beneficiary): Is this an Irrevocable Life Insurance Trust? £ Yes No (If yes and this designation is for a Split Dollar agreement, an Assignment of Rights form should be completed.)£ No
Appears in 1 contract
Samples: Directors’ Supplemental Insurance Plan Agreement (Bank Holdings)
Trust as a Primary Designation. Name of the TrustTrust : Execution Date of the TrustTrust : / / Name of the TrusteeTrustee : Beneficiary(ies) of the Trust (please indicate the percentage for each beneficiary): Is this an Irrevocable Life Insurance Trust? Yes No (If yes and this designation is for a Split Dollar agreement, an Assignment of Rights form should be completed.)
Appears in 1 contract
Samples: Executive Supplemental Retirement Plan Agreement (Bank of Granite Corp)
Trust as a Primary Designation. Name of the Trust: Execution Date of the Trust: / / Trust Name of the Trustee: Beneficiary(ies) Beneficiary of the Trust (please Trust:(Please indicate the percentage for each beneficiary): Name(s): Name(s): Is this an Irrevocable Life Insurance Trust? ☐ Yes No (If yes and this designation is for a Split Dollar agreement, an Assignment of Rights form should be completed.)☐ No
Appears in 1 contract
Samples: Executive Salary Continuation Agreement (Origin Bancorp, Inc.)
Trust as a Primary Designation. Name of the Trust: Execution Date of the Trust: / / Name of the Trustee: Beneficiary(ies) of the Trust Trust: (please indicate the percentage for each beneficiary): Name(s): Name(s): Is this an Irrevocable Life Insurance Trust? o Yes o No (If yes and this designation is for a Split Dollar agreementJoint Beneficiary Designation Agreement, an Assignment of Rights form should must be completed.)
Appears in 1 contract
Samples: Executive Salary Continuation Agreement (Centra Financial Holdings Inc)
Trust as a Primary Designation. Name of the Trust: Execution Date of the Trust: / / Name of the Trustee: Beneficiary(ies) of the Trust Trust: (please indicate the percentage for each beneficiary): Name(s): Name(s): Is this an Irrevocable Life Insurance Trust? Yes No oYes oNo (If yes and this designation is for a Split Dollar agreementJoint Beneficiary Agreement, an Assignment of Rights form should must be completed.)
Appears in 1 contract
Samples: Executive Supplemental Retirement Plan Agreement (Merrill Merchants Bancshares Inc)
Trust as a Primary Designation. Name of the Trust: Execution Date of the Trust: / / Name of the Trustee: Beneficiary(ies) of the Trust (please indicate the percentage for each beneficiary): Is this an Irrevocable Life Insurance Trust? Yes No (If yes and this designation is for a Split Dollar agreement, an Assignment of Rights form should be completed.)
Appears in 1 contract
Samples: Director Supplemental Retirement Agreement (Peoples Bancorp of North Carolina Inc)
