Trust as a Secondary (Contingent) 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): ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ All sums payable under the Life Insurance Endorsement Method Split Dollar Plan Agreement by reason of my death shall be paid to the Primary Beneficiary(ies), if he or she survives me, and if no Primary Beneficiary(ies) shall survive me, then to the Secondary (Contingent) Beneficiary(ies). This beneficiary designation is valid until the participant notifies the bank in writing.
Trust as a Secondary (Contingent) 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): ___________________________________________________________________________ All sums payable under the Executive Supplemental Compensation Agreement by reason of my death shall be paid to the Primary Beneficiary(ies), if he or she survives me, and if no Primary Beneficiary(ies) shall survive me, then to the Secondary (Contingent) Beneficiary(ies). This beneficiary designation is valid until the participant notifies the bank in writing. Insured Date NOTE*** IF YOU RESIDE IN A COMMUNITY PROPERTY STATE (ARIZONA, CALIFORNIA, IDAHO, LOUISIANA, NEVADA, NEW MEXICO, TEXAS, WASHINGTON OR WISCONSIN), AND YOU ARE DESIGNATING A BENEFICIARY OTHER THAN YOUR SPOUSE, THEN YOUR SPOUSE MUST ALSO SIGN THE BENEFICIARY DESIGNATION FORM. I am aware that my spouse, the above named Insured has designated someone other than me to be the beneficiary and waive any rights I may have to the proceeds of such insurance under applicable community property laws. I understand that this consent and waiver supersedes any prior spousal consent or waiver under this plan. Spouse Signature:______________________________ Date:_________________ Witness (other than insured) : ___________________________
Trust as a Secondary (Contingent) 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): Name(s): Name(s): Is this an Irrevocable Life Insurance Trust? ¨ Yes ¨ No (If yes and this designation is for a Joint Beneficiary Designation Agreement, an Assignment of Rights form must be completed.)
Trust as a Secondary (Contingent) 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): All sums payable under the Second Amended and Restated Split Dollar Agreement by reason of my death shall be paid to the Primary Beneficiary(ies), if he or she survives me, and if no Primary Beneficiary(ies) shall survive me, then to the Secondary (Contingent) Beneficiary(ies). This beneficiary designation is valid until the participant notifies the bank in writing. Date: Insured: Xxxx X. Xxxxxxx
Trust as a Secondary (Contingent) Designation. Name of the Trust: Execution Date of the Trust: / / Name of the Trustee: All sums payable under this First Amended and Restated Heritage Commerce Corp Deferred Fee Agreement, by reason of my death shall be paid to the Primary Beneficiary(ies), if he or she survives me, and if no Primary Beneficiary(ies) shall survive me, then to the Secondary (Contingent) Beneficiary(ies). This beneficiary designation is valid until the Participant notifies the Company in writing. Participant Date Witness – Other than a Beneficiary Date NOTE*** IF YOU RESIDE IN A COMMUNITY PROPERTY STATE (ARIZONA, CALIFORNIA, IDAHO, LOUISIANA, NEVADA, NEW MEXICO, TEXAS, WASHINGTON OR WISCONSIN), AND YOU ARE DESIGNATING A BENEFICIARY OTHER THAN YOUR SPOUSE, THEN YOUR SPOUSE MUST ALSO SIGN THE BENEFICIARY DESIGNATION FORM. I am aware that my spouse, the above named Participant has designated someone other than me to be the beneficiary under this First Amended and Restated Heritage Commerce Corp Deferred Fee Agreement, and I hereby waive any rights I may have to the potential benefits thereunder and under applicable community property laws. I understand that this consent and waiver supersedes any prior spousal consent or waiver under this plan. Spouse Signature: Date: Witness (other than Participant):
Trust as a Secondary (Contingent) 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): ___________________________________________________________________________
Trust as a Secondary (Contingent) 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): ________________________________________________________________________________ ________________________________________________________________________________ All sums payable under the Executive Supplemental Retirement Plan Agreement by reason of my death shall be paid to the Primary Beneficiary(ies), if he or she survives me, and if no Primary Beneficiary(ies) shall survive me, then to the Secondary (Contingent) Beneficiary(ies). This beneficiary designation is valid until the participant notifies the bank in writing. Date RESOLUTION OF THE BOARD OF DIRECTORS OF BAY-VANGUARD FEDERAL SAVINGS BANK
Trust as a Secondary (Contingent) Designation. Name of the Trust: 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): All sums payable under the Agreement by reason of my death shall be paid to the Primary Beneficiary(ies), if he or she survives me, and if no Primary Beneficiary(ies) shall survive me, then to the Secondary (Contingent) Beneficiary(ies). This beneficiary designation is valid until the participant notifies the Bank in writing. /s/Director’s Name 9/15/2005 Participant Date
Trust as a Secondary (Contingent) 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): _____________________________________________________________________________________________ _____________________________________________________________________________________________ All sums payable under the Executive Supplemental Retirement Plan Agreement by reason of my death shall be paid to the Primary Beneficiary(ies), if he or she survives me, and if no Primary Beneficiary(ies) shall survive me, then to the Secondary (Contingent) Beneficiary(ies). This beneficiary designation is valid until the Executive notifies the Bank in writing. Xxxx X. Xxxx, Xx. Date EXHIBIT “A-1” For Xxxx X. Xxxx, Xx. End of Year Age: Benefit Amount Xxxx X. Xxxx, Xx. 67 $17,149 68 $53,133 69 $54,134 70 $55,174 71 $56,118 72 $57,198 73 $58,457 74 $59,779 75 $61,057 76 $62,159 77 $63,358 78 $64,249
Trust as a Secondary (Contingent) 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): All sums payable under the Director Salary Continuation Plan Agreement that supercedes and replaces the Director Supplemental Retirement Plan Director Agreement by reason of my death shall be paid to the Primary Beneficiary(ies), if he or she survives me, and if no Primary Beneficiary(ies) shall survive me, then to the Secondary (Contingent) Beneficiary(ies). This beneficiary designation is valid until the participant notifies the bank in writing. XXXXX X. XXXXXXXXX DATE
