Common use of BENEFICIARY OR ALTERNATE Clause in Contracts

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

BENEFICIARY OR ALTERNATE. PAYEE INFORMATION (IF APPLICABLEIFAPPLICABLE) 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

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 forthe 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

BENEFICIARY OR ALTERNATE. PAYEE INFORMATION (IF APPLICABLEIFAPPLICABLE) Check here if you are the surviving spouse or other beneficiary for the Former Participant or eligible Current Participant and the Former Participant or eligible Current 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 forthe Former Participant or eligible Current 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