Common use of Death Beneficiary Designation Clause in Contracts

Death Beneficiary Designation. The following Death Beneficiaries will be entitled to receive any benefits upon the Designated Beneficiary's death. If the primary or contingent status is not indicated, the individual or entity will be considered a primary beneficiary. Upon the Designated Beneficiary's death, the Xxxxxxxxx ESA assets will be divided in equal shares (unless indicated otherwise) to the primary beneficiaries who survive the Designated Beneficiary. If no primary beneficiaries survive the Designated Beneficiary, the Xxxxxxxxx ESA will be divided in equal shares (unless indicated otherwise) to the contingent beneficiaries who survive the Designated Beneficiary. The beneficiary designation may be changed or revoked at any time by completing a new Xxxxxxxxx ESA Change of Designation Form and providing it to the ESA Custodian.  Primary  Contingent Name of beneficiary Social Security Number Date of Birth Address City State ZIP Relationship % of Account  Primary  Contingent Name of beneficiary Social Security Number Date of Birth Address City State ZIP Relationship % of Account  Addendum attached for additional beneficiaries. If you need additional space to name beneficiaries, attach a separate sheet that includes all information requested above. Sign and date the sheet. To name a Trust as your beneficiary, attach to this form either a copy of the Trust Agreement, or a certification, in writing, acceptable to the ESA Custodian. CONSENT OF SPOUSE This section is only completed if the Designated Beneficiary is married and has legal residence in a community or marital property state and someone other than or in addition to the Designated Beneficiary’s spouse is named as Death Beneficiary. This section may have important tax consequences to the Designated Beneficiary and the Designated Beneficiary’s spouse, so please consult with a competent advisor prior to completing. If the Designated Beneficiary is not currently married, but marries You certify that you understand the risk factors and special considerations associated with investing in the CESA Program including the possibility of losing all of your investment. Furthermore, you acknowledge the suitability of this investment in the investment portfolio. You direct Computershare Trust Company to apply dividends and any contributions made to this CESA to the purchase of shares of Altria Group, Inc Stock under the Plan. You understand all dividends paid on Altria Group, Inc Stock held in your CESA will be reinvested in additional shares. in the future, a new beneficiary designation that includes the spousal consent provisions must be completed. Depositor Signature Date By signing below, I acknowledge that I am the spouse of the ESA Designated Beneficiary and agree with and consent to the designation of a primary Death Beneficiary other than, or in addition to, me. I have been advised to consult a competent advisor and I assume all responsibility regarding this consent. The Custodian has not provided me any legal or tax advice. Signature of Spouse of Designated Beneficiary: Signature of Spouse Date Witness Date

Death Beneficiary Designation. The following Death Beneficiaries will be entitled to receive any benefits upon the Designated Beneficiary's death. If the primary or contingent status is not indicated, the individual or entity will be considered a primary beneficiary. Upon the Designated Beneficiary's death, the Xxxxxxxxx ESA assets will be divided in equal shares (unless indicated otherwise) to the primary beneficiaries who survive the Designated Beneficiary. If no primary beneficiaries survive the Designated Beneficiary, the Xxxxxxxxx ESA will be divided in equal shares (unless indicated otherwise) to the contingent beneficiaries who survive the Designated Beneficiary. The beneficiary designation may be changed or revoked at any time by completing a new Xxxxxxxxx ESA Change of Designation Form and providing it to the ESA Custodian.  Primary  Contingent Name of beneficiary Social Security Number Date of Birth Address City State ZIP Relationship % of Account  Primary  Contingent Name of beneficiary Social Security Number Date of Birth Address City State ZIP Relationship % of Account  Addendum attached for additional beneficiaries. If you need additional space to name beneficiaries, attach a separate sheet that includes all information requested above. Sign and date the sheet. To name a Trust as your beneficiary, attach to this form either a copy of the Trust Agreement, or a certification, in writing, acceptable to the ESA Custodian. CONSENT OF SPOUSE This section is only completed if the Designated Beneficiary is married and has legal residence in a community or marital property state and someone other than or in addition to the Designated Beneficiary’s spouse is named as Death Beneficiary. This section may have important tax consequences to the Designated Beneficiary and the Designated Beneficiary’s spouse, so please consult with a competent advisor prior to completing. If the Designated Beneficiary is not currently married, but marries in the future, a new beneficiary designation that includes the You certify that you understand the risk factors and special considerations associated with investing in the CESA Program including the possibility of losing all of your investment. Furthermore, you acknowledge the suitability of this investment in the investment portfolio. You direct Computershare Trust Company to apply dividends and any contributions made to this CESA to the purchase of shares of Altria Group, Inc Xxxxxx Xxxxxx International Inc. Stock under the Plan. You understand all dividends paid on Altria Group, Inc Xxxxxx Xxxxxx International Inc. Stock held in your CESA will be reinvested in additional shares. in the future, a new beneficiary designation that includes the spousal consent provisions must be completed. Depositor Signature Date By signing below, I acknowledge that I am the spouse of the ESA Designated Beneficiary and agree with and consent to the designation of a primary Death Beneficiary other than, or in addition to, me. I have been advised to consult a competent advisor and I assume all responsibility regarding this consent. The Custodian has not provided me any legal or tax advice. Signature of Spouse of Designated Beneficiary: Signature of Spouse Date Witness Date

Death Beneficiary Designation. The following Death Beneficiaries will be entitled to receive any benefits upon the Designated Beneficiary's death. If the primary or contingent status is not indicated, the individual or entity will be considered a primary beneficiary. Upon the Designated Beneficiary's death, the Xxxxxxxxx ESA assets will be divided in equal shares (unless indicated otherwise) to the primary beneficiaries who survive the Designated Beneficiary. If no primary beneficiaries survive the Designated Beneficiary, the Xxxxxxxxx ESA will be divided in equal shares (unless indicated otherwise) to the contingent beneficiaries who survive the Designated Beneficiary. The beneficiary designation may be changed or revoked at any time by completing a new Xxxxxxxxx ESA Change of Designation Form and providing it to the ESA Custodian.  Primary  Contingent Name of beneficiary Social Security Number Date of Birth Address City State ZIP Relationship % of Account  Primary  Contingent Name of beneficiary Social Security Number Date of Birth Address City State ZIP Relationship % of Account  Addendum attached for additional beneficiaries. If you need additional space to name beneficiaries, attach a separate sheet that includes all information requested above. Sign and date the sheet. To name a Trust as your beneficiary, attach to this form either a copy of the Trust Agreement, or a certification, in writing, acceptable to the ESA Custodian. CONSENT OF SPOUSE This section is only completed if the Designated Beneficiary is married and has legal residence in a community or marital property state and someone other than or in addition to the Designated Beneficiary’s spouse is named as Death Beneficiary. This section may have important tax consequences to the Designated Beneficiary and the Designated Beneficiary’s spouse, so please consult with a competent advisor prior to completing. If the Designated Beneficiary is not currently married, but marries You certify that you understand the risk factors and special considerations associated with investing in the CESA Program including the possibility of losing all of your investment. Furthermore, you acknowledge the suitability of this investment in the investment portfolio. You direct Computershare Trust Company to apply dividends and any contributions made to this CESA to the purchase of shares of Altria GroupWal-Mart Stores, Inc Stock under the Plan. You understand all dividends paid on Altria GroupWal-Mart Stores, Inc Stock held in your CESA will be reinvested in additional shares. in the future, a new beneficiary designation that includes the spousal consent provisions must be completed. Depositor Signature Date By signing below, I acknowledge that I am the spouse of the ESA Designated Beneficiary and agree with and consent to the designation of a primary Death Beneficiary other than, or in addition to, me. I have been advised to consult a competent advisor and I assume all responsibility regarding this consent. The Custodian has not provided me any legal or tax advice. Signature of Spouse of Designated Beneficiary: Signature of Spouse Date Witness Date

Death Beneficiary Designation. The following Death Beneficiaries will be entitled to receive any benefits upon the Designated Beneficiary's death. If the primary or contingent status is not indicated, the individual or entity will be considered a primary beneficiary. Upon the Designated Beneficiary's death, the Xxxxxxxxx ESA assets will be divided in equal shares (unless indicated otherwise) to the primary beneficiaries who survive the Designated Beneficiary. If no primary beneficiaries survive the Designated Beneficiary, the Xxxxxxxxx ESA will be divided in equal shares (unless indicated otherwise) to the contingent beneficiaries who survive the Designated Beneficiary. The beneficiary designation may be changed or revoked at any time by completing a new Xxxxxxxxx ESA Change of Designation Form and providing it to the ESA Custodian.  Primary  Contingent Name of beneficiary Social Security Number Date of Birth Address City State ZIP Relationship % of Account  Primary  Contingent Name of beneficiary Social Security Number Date of Birth Address City State ZIP Relationship % of Account  Addendum attached for additional beneficiaries. If you need additional space to name beneficiaries, attach a separate sheet that includes all information requested above. Sign and date the sheet. To name a Trust as your beneficiary, attach to this form either a copy of the Trust Agreement, or a certification, in writing, acceptable to the ESA Custodian. CONSENT OF SPOUSE This section is only completed if the Designated Beneficiary is married and has legal residence in a community or marital property state and someone other than or in addition to the Designated Beneficiary’s spouse is named as Death Beneficiary. This section may have important tax consequences to the Designated Beneficiary and the Designated Beneficiary’s spouse, so please consult with a competent advisor prior to completing. If the Designated Beneficiary is not currently married, but marries You certify that you understand the risk factors and special considerations associated with investing in the CESA Program including the possibility of losing all of your investment. Furthermore, you acknowledge the suitability of this investment in the investment portfolio. You direct Computershare Trust Company to apply dividends and any contributions made to this CESA to the purchase of shares of Altria Group, Inc Ford Motor Company Stock under the Plan. You understand all dividends paid on Altria Group, Inc Ford Motor Company Stock held in your CESA will be reinvested in additional shares. in the future, a new beneficiary designation that includes the spousal consent provisions must be completed. Depositor Signature Date By signing below, I acknowledge that I am the spouse of the ESA Designated Beneficiary and agree with and consent to the designation of a primary Death Beneficiary other than, or in addition to, me. I have been advised to consult a competent advisor and I assume all responsibility regarding this consent. The Custodian has not provided me any legal or tax advice. Signature of Spouse of Designated Beneficiary: Signature of Spouse Date Witness Date