"Beneficiary Form - Ohio Deferred Compensation" - Ohio

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BENEFICIARY FORM
Print Form
READ NEXT PAGE FOR INSTRUCTIONS
Name___________________________________________________________________________________
SS# __________ – _______ – _______________ Employer Code ___________________________ Suffix _______
Primary Beneficiary
SS# __________ – _______ – _______________
1. Name_____________________________________________
Relationship________________________________________
Date of Birth______________ Percentage____________
SS# __________ – _______ – _______________
2. Name_____________________________________________
Relationship________________________________________
Date of Birth______________ Percentage____________
SS# __________ – _______ – _______________
3. Name_____________________________________________
Relationship________________________________________
Date of Birth______________ Percentage____________
SS# __________ – _______ – _______________
4. Name_____________________________________________
Relationship________________________________________
Date of Birth______________ Percentage____________
PERCENTAGES MUST EQUAL 100% AND NOT EXCEED 100% IN EACH CATEGORY
Contingent Beneficiary
SS# __________ – _______ – _______________
1. Name_____________________________________________
Relationship________________________________________
Date of Birth______________ Percentage____________
SS# __________ – _______ – _______________
2. Name_____________________________________________
Relationship________________________________________
Date of Birth______________ Percentage____________
SS# __________ – _______ – _______________
3. Name_____________________________________________
Relationship________________________________________
Date of Birth______________ Percentage____________
SS# __________ – _______ – _______________
4. Name_____________________________________________
Relationship________________________________________
Date of Birth______________ Percentage____________
PERCENTAGES MUST EQUAL 100% AND NOT EXCEED 100% IN EACH CATEGORY
Do not check this box if you have chosen a primary/contingent beneficiary above.
My estate will be my primary beneficiary until I submit another properly completed Beneficiary Form. I understand that
distributions from my estate may be required to be approved by probate court according to applicable state law.
I hereby designate the above beneficiary(ies) to receive benefits payable under the Plan, if any, in the event of my death.
____________________________________________________________
______________________________________
Participant's Signature
Date
OHIO-0781-0515/WEB
BENEFICIARY FORM
Print Form
READ NEXT PAGE FOR INSTRUCTIONS
Name___________________________________________________________________________________
SS# __________ – _______ – _______________ Employer Code ___________________________ Suffix _______
Primary Beneficiary
SS# __________ – _______ – _______________
1. Name_____________________________________________
Relationship________________________________________
Date of Birth______________ Percentage____________
SS# __________ – _______ – _______________
2. Name_____________________________________________
Relationship________________________________________
Date of Birth______________ Percentage____________
SS# __________ – _______ – _______________
3. Name_____________________________________________
Relationship________________________________________
Date of Birth______________ Percentage____________
SS# __________ – _______ – _______________
4. Name_____________________________________________
Relationship________________________________________
Date of Birth______________ Percentage____________
PERCENTAGES MUST EQUAL 100% AND NOT EXCEED 100% IN EACH CATEGORY
Contingent Beneficiary
SS# __________ – _______ – _______________
1. Name_____________________________________________
Relationship________________________________________
Date of Birth______________ Percentage____________
SS# __________ – _______ – _______________
2. Name_____________________________________________
Relationship________________________________________
Date of Birth______________ Percentage____________
SS# __________ – _______ – _______________
3. Name_____________________________________________
Relationship________________________________________
Date of Birth______________ Percentage____________
SS# __________ – _______ – _______________
4. Name_____________________________________________
Relationship________________________________________
Date of Birth______________ Percentage____________
PERCENTAGES MUST EQUAL 100% AND NOT EXCEED 100% IN EACH CATEGORY
Do not check this box if you have chosen a primary/contingent beneficiary above.
My estate will be my primary beneficiary until I submit another properly completed Beneficiary Form. I understand that
distributions from my estate may be required to be approved by probate court according to applicable state law.
I hereby designate the above beneficiary(ies) to receive benefits payable under the Plan, if any, in the event of my death.
____________________________________________________________
______________________________________
Participant's Signature
Date
OHIO-0781-0515/WEB
BENEFICIARY FORM INSTRUCTIONS
1.
You may choose an individual, your estate, a trust, or charitable organization as your
beneficiary. Your contingent beneficiaries will only be paid if all of your primary beneficiaries
are not living at the time of your death. Attach additional sheets, if necessary.
2.
You cannot name the same person as both primary and contingent beneficiary.
3.
All information on the Beneficiary Form must be completed for processing. You must include
the beneficiary's Social Security number or tax identification number, relationship, birth date,
and percentage. Percentages must equal 100% and not exceed 100% in each category.
Beneficiary Forms are legal documents. You must initial any changes made on the form.
4.
If you are choosing a trust as your beneficiary, the Program must have a copy of the trust to
process the form.
5.
If you choose your estate, trust, or charitable organization as your primary beneficiary, there
is no contingent beneficiary. You may choose an individual as your primary beneficiary
and choose your estate, trust, or charity as your contingent beneficiary in case the primary
beneficiary is not living at the time of your death.
6.
Beneficiaries who are minors (under the age of 18) will not receive a distribution unless a
legal guardian is appointed. If this is the case, payments will be made to the guardian on
behalf of the minor.
7.
Be sure to sign and date the form before mailing. Please keep a copy for your records.
8.
If you have any questions, please contact our Service Center at 877-644-6457.
Return form to:
Ohio Deferred Compensation
257 East Town Street, Suite 457
Columbus, Ohio 43215-4626
OHIO-0781-0515/WEB
OHIO DC
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