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 5 contracts
Samples: Executive Supplemental Compensation Agreement (Pacific Financial Corp), Executive Supplemental Compensation Agreement (Pacific Financial Corp), Supplemental Compensation Agreement (Columbia Banking System 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 3 contracts
Samples: Executive Salary Continuation Plan Agreement (Osage Federal Financial Inc), Executive Salary Continuation Plan Agreement (Osage Federal Financial Inc), Executive Salary Continuation Plan Agreement (Osage Federal Financial 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) _______________________________________________________________________________ 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 2 contracts
Samples: Split Dollar Life Insurance Agreement (Venture Financial Group Inc), Participation Agreement (Venture Financial Group 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 Fee Continuation Agreement (GCF 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 (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 (Citizens Financial Corp/De/)
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: Executive Supplemental Retirement Plan (BV Financial, 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 Plan (BV Financial, Inc.)
Trust as a Primary Designation. Name of the Trust: ____________________________________________________________________________________________ Execution Date of the Trust: _____ / _____ / Name of the Trustee: _________ 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: Supplemental Compensation Agreement (Columbia Banking System 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: Endorsement Method Split Dollar Plan (Crescent Banking Co)
Trust as a Primary Designation. Name of the Trust: ____________________________________________________________________ Execution Date of the Trust: _____ / _____ / Name of the Trustee: _________ 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
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
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 agreementAgreement, an Assignment of Rights form should be completed.)
Appears in 1 contract
Samples: Executive Supplemental Retirement Plan Agreement (New Century 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 (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 (Citizens Financial Corp/De/)
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: Executive Salary Continuation Plan Agreement (Osage Federal Financial 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.)
A. Person(s) as a Secondary (Contingent) Designation:
Appears in 1 contract
Samples: Executive Supplemental Compensation Agreement (Pacific 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 (please indicate the percentage for each beneficiary): ___________________________________________________________________________ Is this an Irrevocable Life Insurance Trust? ________ Yes ________ No 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 Compensation Agreement (Five Star Bancorp)
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: Endorsement Method Split Dollar Plan Agreement (Greater Bay Bancorp)
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 beneficiaryBeneficiary): ___________________________________________________________________________ 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: Split Dollar Agreement (Heritage Financial Corp /Wa/)
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: Executive Incentive Retirement Plan Agreement (GCF 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 (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 (Crescent Banking Co)
