BENEFICIARY OR ALTERNATE PAYEE INFORMATION Sample Clauses

BENEFICIARY OR ALTERNATE PAYEE INFORMATION. (IF APPLICABLE) Check here if you are the surviving spouse or other beneficiary for the Former Participant and the Former Participant is deceased. Documentation must be provided showing current authority of the representative to file on behalf of the deceased. Please complete the information below and then continue on to Parts 4 and 5 on the next page. Check here if you are an alternate payee under a qualified domestic relations order (QDRO), or attorney-in-fact for the Former Participant. The Settlement Administrator may contact you with further instructions. Please complete the information below and then continue on to Parts 4 and 5 on the next page. Your First Name Middle Last Name Your Social Security Number or Tax ID Number Your Date of Birth Your Mailing Address M X X X X X X X Xxxx Xxxxx Zip Code
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BENEFICIARY OR ALTERNATE PAYEE INFORMATION. (IF APPLICABLE) Check here if you are the surviving spouse or other beneficiary for the Former Participant and the Former Participant is deceased. Documentation must be provided showing current authority of the representative to file on behalf of the deceased. Please complete the information below and then continue on to Parts 4 and 5 on the next page. Check here if you are an alternate payee under a qualified domestic relations order (QDRO), or attorney-in-fact for the Former Participant. The Settlement Administrator may contact you with further instructions. Please complete the information below and then continue on to Parts 4 and 5 on the next page. Your First Name Middle Last Name Your Social Security Number or Tax ID Number Your Date of Birth Your Mailing Address M X X X X X X X Xxxx Xxxxx Zip Code PART 4: PAYMENT ELECTION Payment to Self – A check subject to mandatory federal and applicable state withholding tax will be mailed to your address on the previous page. Direct Rollover to an Eligible Plan – Check only one box below and complete Rollover Information Section Below: Government 457(b) 401(a)/401(k) 403(b) Direct Rollover to a Traditional XXX Direct Rollover to a Xxxx XXX (subject to ordinary income tax) Rollover Information: Company or Trustee’s Name (to whom the check should be made payable) Company or Trustee’s Mailing Address 1 Company or Trustee’s Mailing Address 2 Company or Trustee’s City State Zip Code Account Number Company or Trustee’s Phone Number PART 5: SIGNATURE, CONSENT, AND SUBSTITUTE IRS FORM W-9 UNDER PENALTIES OF PERJURY UNDER THE LAWS OF THE UNITED STATES OF AMERICA, I CERTIFY THAT ALL OF THE INFORMATION PROVIDED ON THIS FORMER PARTICIPANT CLAIM FORM IS TRUE, CORRECT, AND COMPLETE AND THAT I SIGNED THIS FORMER PARTICIPANT CLAIM FORM.
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BENEFICIARY OR ALTERNATE PAYEE INFORMATION. (IF APPLICABLE) Check here if you are the surviving spouse or other beneficiary for the Former Participant and the Former Participant is deceased. Documentation must be provided showing current authority of the representative to file on behalf of the deceased. Please complete the information below and then continue on to Parts 4 and 5 on the next page. Check here if you are an alternate payee under a qualified domestic relations order (QDRO). The Settlement Administrator may contact you with further instructions. Please complete the information below and then continue on to Parts 4 and 5 on the next page. Your First Name Middle Last Name Your Social Security Number or Tax ID Number Your Date of Birth Your Mailing Address City, State, ZIP M M D D Y Y Y Y PART 4: PAYMENT ELECTION Payment to Self – A check subject to mandatory federal and applicable state withholding tax will be mailed to your address on the previous page. Direct Rollover to an Eligible Plan – Check only one box below and complete the Rollover Information Section below: Government 457(b) 401(a)/401(k) 403(b) Direct Rollover to a Traditional IRA Direct Rollover to a Xxxx XXX (subject to ordinary income tax) Rollover Information: Company or Trustee’s Name (to whom the check should be made payable) Company or Trustee’s Mailing Address 1 Company or Trustee’s Mailing Address 2 Company or Trustee’s City State Zip Code Your Account Number Company or Trustee’s Phone Number
Sample 1
BENEFICIARY OR ALTERNATE PAYEE INFORMATION. (IF APPLICABLE) Check here if you are the surviving spouse or other beneficiary for the Former Participant. The Settlement Administrator will contact you with further instructions. Check here if you are an alternate payee under a qualified domestic relations order (QDRO), or attorney-in-fact for the Former Participant. The Settlement Administrator will contact you with further instructions. Your Social Security Number or Tax ID Number Your Date of Birth Your Mailing Address M X X X X X X X Xxxx Xxxxx Zip Code
Sample 1
BENEFICIARY OR ALTERNATE PAYEE INFORMATION. (IF APPLICABLE) ☐ Check here if you are the surviving spouse or other beneficiary for the Former Participant and the Former Participant is deceased. Documentation must be provided showing current authority of the representative to file on behalf of the deceased. Please complete the information below and then continue on to Parts 4 and 5 on the next page. ☐ Check here if you are an alternate payee under a qualified domestic relations order (QDRO). The Settlement Administrator may contact you with further instructions. Please complete the information below and then continue on to Parts 4 and 5 on the next page. [ROLLOVER FORM CONTINUES ON THE NEXT PAGE] PART 4: PAYMENT ELECTION Direct Rollover to an Eligible Plan – Check only one box below and complete the Rollover Information Section below: ☐ Government 457(b) ☐ 401(a)/401(k) ☐ 403(b) ☐ Direct Rollover to a Traditional IRA ☐ Direct Rollover to a Xxxx XXX (subject to ordinary income tax) Rollover Information:
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Related to BENEFICIARY OR ALTERNATE PAYEE INFORMATION

  • Alternate Payee A. Pursuant to the provisions of the Assumption of Liability Endorsement, the Reinsurer has agreed that, in lieu of payment to the Company or its receiver, rehabilitator, liquidator, conservator, or other statutory successor, it shall pay valid claims under the Policy directly to the Insured, at the Insured's request, if a Cut Through Triggering Event (as that term is defined in the Assumption of Liability Endorsement) occurs.

  • How do the RMD Rules Impact my Designated Beneficiary or Beneficiaries The RMD rules provide for the determination of your designated beneficiary or beneficiaries as of September 30 of the year following your death. Consequently, any beneficiary may be eliminated for purposes of calculating the RMD by the distribution of that beneficiary’s benefit, through a valid disclaimer between your death and the end of September following the year of your death, or by dividing your IRA account into separate accounts for each of several designated beneficiaries you may have designated.

  • Beneficiary Rollovers from Employer-Sponsored Retirement Plans If you are a spouse Beneficiary, nonspouse Beneficiary, or the trustee of an eligible type of trust named as Beneficiary of a deceased employer plan participant, you may directly roll over inherited assets from a qualified retirement plan, 403(a) annuity, 403(b) tax-sheltered annuity, or 457(b) governmental deferred compensation plan to an inherited IRA. The IRA must be maintained as an inherited IRA, subject to the beneficiary distribution requirements.

  • Beneficiary The Participant may file with the Committee a written designation of a beneficiary on such form as may be prescribed by the Committee and may, from time to time, amend or revoke such designation.

  • Multiple Individual Retirement Accounts In the event the depositor maintains more than one Individual Retirement Account (as defined in Section 408(a)) and elects to satisfy his or her minimum distribution requirements described in Article IV above by making a distribution from another individual retirement account in accordance with Item 6 thereof, the depositor shall be deemed to have elected to calculate the amount of his or her minimum distribution under this custodial account in the same manner as under the Individual Retirement Account from which the distribution is made.

  • Designated Beneficiary The individual who is designated as the Beneficiary under the Plan and is the designated beneficiary under Section 401(a)(9) of the Internal Revenue Code and Section 1.401(a)(9)-1, Q&A-4, of the Treasury regulations.

  • Intended Beneficiaries Nothing in this Agreement shall be construed to give any person or entity other than the parties hereto any legal or equitable claim, right or remedy. Rather, this Agreement is intended to be for the sole and exclusive benefit of the parties hereto.

  • Designation of Beneficiary The depositor may designate a beneficiary or beneficiaries to receive benefits from the custodial account in the event of the depositor’s death. In the event the depositor has not designated a beneficiary, or if all beneficiaries shall predecease the depositor, the following persons shall take in the order named:

  • Other New Individual Accounts With respect to New Individual Accounts not described in paragraph A of this section, upon account opening (or within 90 days after the end of the calendar year in which the account ceases to be described in paragraph A of this section), the Reporting Finnish Financial Institution must obtain a self-certification, which may be part of the account opening documentation, that allows the Reporting Finnish Financial Institution to determine whether the Account Holder is resident in the United States for tax purposes (for this purpose, a U.S. citizen is considered to be resident in the United States for tax purposes, even if the Account Holder is also a tax resident of another jurisdiction) and confirm the reasonableness of such self-certification based on the information obtained by the Reporting Finnish Financial Institution in connection with the opening of the account, including any documentation collected pursuant to AML/KYC Procedures.

  • Beneficiary Designations The Executive shall designate a beneficiary by filing a written designation with the Company. The Executive may revoke or modify the designation at any time by filing a new designation. However, designations will only be effective if signed by the Executive and accepted by the Company during the Executive's lifetime. The Executive's beneficiary designation shall be deemed automatically revoked if the beneficiary predeceases the Executive, or if the Executive names a spouse as beneficiary and the marriage is subsequently dissolved. If the Executive dies without a valid beneficiary designation, all payments shall be made to the Executive's estate.

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