Beneficiary Designation Form Sample Clauses

Beneficiary Designation Form. You may designate a primary beneficiary and a secondary beneficiary. You can name more than one person as a primary or secondary beneficiary. For example, you may wish to name your spouse as primary beneficiary and your children as secondary beneficiaries. Your secondary beneficiary(ies) will receive nothing if any of your primary beneficiaries survive you. All primary beneficiaries will share equally unless you indicate otherwise. The same rule applies for secondary beneficiaries. Designate Your Beneficiary(ies): Primary Beneficiary(ies): Secondary Beneficiary(ies): I certify that my designation of beneficiary set forth above is my free act and deed. Name of Employee Employee’s Signature (Please Print) Date
Beneficiary Designation Form. “Beneficiary Designation Form” shall mean the form established from time to time by the Bank and the Administrator, which an Insured completes, signs and returns in order to designate one or more Beneficiaries.
Beneficiary Designation Form. With respect to the Trustee Deferred Compensation Agreement (the “Agreement”) by and between the undersigned and the Invesco Funds: I hereby revoke any prior designation of beneficiary(ies), if applicable, and make the following beneficiary designations:4
Beneficiary Designation Form. GENERAL INFORMATION Use this form to designate the Beneficiary(ies) who will receive vested stock options outstanding to you at the time of your death. Name of Award Recipient Social Security Number – –
Beneficiary Designation Form. As an Executive participating in a Supplemental Executive Retirement Agreement with Txxxxxxx Financial Corporation, I hereby designate my spouse to receive any death benefits that may become payable under the Agreement. I understand and acknowledge no death benefit will be paid under the Agreement (a) if the below-designated Spouse is not a “Surviving Spouse” as defined in the Agreement, or (b) if I do not return this Spousal Benefit Designation Form, completed and executed, to the Committee on or before my Retirement Date, as defined in the Agreement. Spouse’s Name: ___________________________________ Social Security Number: _____________________________ Date of Birth: ______________________________ Home Address: ____________________________________________________________ Executive’s Signature: ______________________________ Witness’ Signature: ______________________________
Beneficiary Designation Form. GENERALINFORMATION Use this form to designate the Beneficiary(ies) who may receive Shares that become vested at your death. Name of PersonMaking Designation Social Security Number ______-_____-______ BENEFICIARYDESIGNATION Complete sections A and B. If no percentage shares are specified, each Beneficiary in the same class (primary or contingent) shall have an equal share. If any designated Beneficiary predeceases you, the shares of each remaining Beneficiary in the same class (primary or contingent) shall be increased proportionately. A PRIMARY BENEFICIARY(IES). I hereby designate the following person as my primary Beneficiary under the Plan, reserving the right to change or revoke this designation at any time prior to my death: Name Address Relationship Birthdate Share % % %Total=100% B CONTINGENT BENEFICIARY(IES). I hereby designate the following person(s) as my contingent Beneficiary(ies) under the Plan to receive benefits only if all of my primary Beneficiaries should predecease me, reserving the right to change or revoke this designation at any time prior to my death as to all outstanding Awards: Name Address Relationship Birthdate Share % % %Total=100% SIGN HERE I understand that this Beneficiary Designation shall be effective only if properly completed and received by the Corporate Secretary of Sterling Bancorp prior to my death, and that it is subject to all of the terms and conditions of the Plan. I also understand that an effective Beneficiary designation revokes my prior designation(s) with respect to all outstanding Awards. Your Signature Date ---------------------------------------------------- Internal Use Only ------------------------------------------------------------ This Beneficiary Designation was received by the Corporate Secretary of Xxxxxxxx Xxxxxxx on the date indicated. By Authorized Signature Date Comments EXHIBIT B STERLING BANCORP 2015 OMNIBUS EQUITY AND INCENTIVE PLAN 2019 CEO Supplemental Performance Stock Award Notice Performance Goals [Applicable Measures and targets to be determined by the Compensation Committee]
Beneficiary Designation Form. GENERAL INFORMATION Use this form to designate the Beneficiary(ies) who will receive vested stock options outstanding to you at the time of your death. Name of Person Making Designation______________________________________________________________ Social Security Number ______—_____—______
Beneficiary Designation Form. I, Xxxxx X. Xxxxx, designate as my Beneficiary to benefits under this Agreement, . If my designated Beneficiary shall not survive me, I designate as my Contingent Beneficiary to benefits under this Agreement. I understand that the only way that I can change my Beneficiary or Contingent Beneficiary under this Agreement is to complete a revised Beneficiary Designation Form to this Agreement and communicate such revised form to the Company. Xxxxx X. Xxxxx Witness: FIRST AMENDMENT TO THE CLARION COUNTY CONNUMITY BANK SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN AGREEMENT For the benefit of Xxxxx X. Xxxxx This First Amendment is adopted this 30th day of January, 2020, by and between Clarion County Community Bank (the “Company”) and Xxxxx X. Xxxxx (the “Participant”).
Beneficiary Designation Form. GENERAL INFORMATION Use this form to designate the Beneficiary(ies) who will receive vested stock options outstanding to you at the time of your death. Name of Person Making Designation___________________________________________________ Social Security Number ______—_____—______ BENEFICIARY DESIGNATION Complete sections A and B. If no percentage shares are specified, each Beneficiary in the same class (primary or contingent) shall have an equal share. If any designated Beneficiary predeceases you, the shares of each remaining Beneficiary in the same class (primary or contingent) shall be increased proportionately.
Beneficiary Designation Form þ New Designation o Change in Designation I, WXXXXXX X. XXXXXXXXX, designate the following as Beneficiary under the Agreement: Primary: Contingent: Notes: • Please PRINT CLEARLY or TYPE the names of the beneficiaries. • To name a trust as Beneficiary, please provide the name of the trustee(s) and the exact name and date of the trust agreement. • To name your estate as Beneficiary, please write “Estate of [your name].” • Be aware that none of the contingent beneficiaries will receive anything unless ALL of the primary beneficiaries predecease you. I understand that I may change these beneficiary designations by delivering a new written designation to the Plan Administrator, which shall be effective only upon receipt and acknowledgment by the Plan Administrator prior to my death. I further understand that the designations will be automatically revoked if the Beneficiary predeceases me, or, if I have named my spouse as Beneficiary and our marriage is subsequently dissolved. Name: Signature: Date: Received by the Plan Administrator this day of , 2006 By: Title: SCHEDULE A COMMUNITY BANK OF TRI-COUNTY SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN AGREEMENT Wxxxxxx X. Xxxxxxxxx Change in Preretirement