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) : ___________________________
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)
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 (ARIZONAWASHINGTON, 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) : ___________________________
Appears in 1 contract
Samples: Supplemental Compensation Agreement (Columbia Banking System Inc)
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 I notify the bank in writing. Insured Executive Date NOTE*** IF YOU RESIDE IN A COMMUNITY PROPERTY STATE (CALIFORNIA, ARIZONA, CALIFORNIA, IDAHO, LOUISIANA, NEVADA, NEW MEXICO, TEXAS, WASHINGTON OR WISCONSIN), AND YOU ARE DESIGNATING A BENEFICIARY OTHER THAN YOUR SPOUSE, THEN IT IS RECOMMENDED THAT YOUR SPOUSE MUST ALSO SIGN THE BENEFICIARY DESIGNATION FORMFORM BELOW. I am aware that my spouse, the above above-named Insured Executive, 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 planplan and applies only to this Beneficiary Designation Form. Spouse Signature:________________________________ Date:___________________ Witness (other than insured) : :________________________________________
Appears in 1 contract
Samples: Executive Supplemental Compensation Agreement (Five Star Bancorp)
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 beneficiaryBeneficiary): ___________________________________________________________________________ ___________________________________________________________________________ All sums payable under the Executive Supplemental Compensation Endorsement Method 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. 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 IT IS RECOMMENDED THAT 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 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) : ___________________________
Appears in 1 contract
Samples: Split Dollar Agreement (Heritage Financial Corp /Wa/)
Trust as a Secondary (Contingent) 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): ___________________________________________________________________________ All sums payable under the Executive Supplemental Compensation 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. 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 IT IS RECOMMENDED THAT YOUR SPOUSE MUST ALSO SIGN THE BENEFICIARY DESIGNATION FORMFORM BELOW. I am aware that my spouse, the above above-named Insured 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 planplan and shall apply only to this Beneficiary Designation Form. Spouse Signature:______________________________ Date:_________________ Witness (other than insured) : ): ___________________________
Appears in 1 contract
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 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 I notify 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 IT IS RECOMMENDED THAT YOUR SPOUSE MUST ALSO SIGN THE BENEFICIARY DESIGNATION FORM. I am aware that my spouse, the above 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 planplan and that it only applies to this Beneficiary Designation Form. Spouse Signature:: Date: Witness (other than insured):______________________________ Date:_________________ Witness (other than insured) : ___________________________
Appears in 1 contract