Life and Death Planning for Retirement Benefits

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Life and Death Planning for Retirement Benefits

III. Other Provisions [dispense with any of these that are not appropriate in view of the choice of beneficiary or that are not necessary because already covered in the plan documents governing the benefits] 3.01 Honoring Disclaimers. If a Beneficiary disclaims all or any portion of any interest in the Death Benefit to which such Beneficiary would otherwise be entitled under the foregoing provisions hereof, by means of a written disclaimer delivered to the Administrator within nine months after my death, then that Beneficiary shall be deemed (as to the interest so disclaimed) to have predeceased me, the interest so disclaimed shall pass as if such Beneficiary had predeceased me, and the Beneficiary who takes the interest so disclaimed shall be deemed to be my beneficiary under the Plan for all purposes. This provision shall not be construed to prevent an interest disclaimed by my spouse from passing to my spouse by other means. 3.02 Information to be provided to Personal Representative. The Administrator shall provide to my Personal Representative any information such representative shall request in connection with the performance of such representative’s duties (including the preparation of any tax return) regarding the benefits, the Plan, and the Beneficiary(ies), including information as to matters prior to such representative’s appointment, and including copies of Plan documents and returns, to the same extent and on the same terms that such information would have been provided to me had I requested it. Any Beneficiary, by accepting benefits hereunder, shall be deemed to have consented to the release of information to my Personal Representative as provided in the preceding sentence. 3.03 Governing Law. The law of the State of _____________ shall apply solely for the purpose of interpreting my intent as expressed in this Designation of Beneficiary form. This provision is not intended to amend or supercede any governing law provision in the Plan with respect to the interpretation and administration of the Plan.

Signed this _____ day of ____________________, 20 _____.

________________________________________ Signature of Participant

Receipt of the above beneficiary designation form is hereby acknowledged this _____ day of ____________________, 20 _____.

________________________________________ Name of Custodian or Trustee

By: _______________________________ [Title]

2.3 Additional Clauses for Master Beneficiary Designations

These clauses can be added to the Master Beneficiary Designations (Forms 2.1 and 2.2) if needed. Use 3.04 if there is any possibility that a minor may become a beneficiary of the plan or account. Use 3.05 if there is any possibility that there could be multiple beneficiaries of the plan or account. If the entire plan benefit or account is payable to a single trust as named beneficiary, for example, there would be no need to use either of these clauses.