Life and Death Planning for Retirement Benefits

Appendix B: Forms

481

________________________________________ Signature of Participant Receipt of the above beneficiary designation form is hereby acknowledged this _____ day of ____________________, 20 _____. ________________________________________ Name of Custodian or Trustee By: _______________________________ [Title] 2.2 Master Beneficiary Designation Form: Qualified Plan DESIGNATION OF BENEFICIARY TO: __________________________________________ Name of Custodian or Trustee of the Account FROM: __________________________________________ Name of Participant RE: __________________________________________ Name of Retirement Plan I. Definitions The following words, when used in this form and capitalized, shall have the meaning indicated in this Section. “Administrator” means the Plan Administrator or Trustee named above, and its successors in such office. “Beneficiary” means any person entitled to receive benefits under the Plan as a result of my death (or as a result of the death of another Beneficiary). “Contingent Beneficiary” means the person(s) I have designated in this form to receive the Death Benefit if my Primary Beneficiary does not survive me (or disclaims the benefits). “Death Benefit” means all benefits payable under the Plan on account of my death. The “Personal Representative” of any person means the duly appointed guardian or conservator of such person, or executor or administrator of such person’s estate, who is serving as such at the applicable time. “Plan” means the qualified retirement plan or other retirement arrangement described at the beginning of this form. “Primary Beneficiary” means the person(s) designated in this form to receive benefits under the Plan on account of my death. II. Designation of Beneficiary [Here insert the name(s) of the primary and contingent beneficiary(ies). This section must be drafted by the estate planning attorney; see sample inserts in Part 3 of this Appendix B . If the