Primary Beneficiary. I designate the following persons as my Primary Beneficiary or Beneficiaries to receive any amount due under the Award Agreement described at the top of this form after my death. This benefit will be paid, in the proportion specified, to: % to (Name) (Relationship) Address: % to (Name) (Relationship) Address: % to (Name) (Relationship) Address: % to (Name) (Relationship) Address:
Primary Beneficiary. I hereby designates the person(s) named below to be my primary beneficiary and to receive the balance of any unpaid portion of my Account. Name of Percentage of Primary Beneficiary Social Security Number Mailing Address Death Benefit ------------------- ---------------------- --------------- ------------- % %
Primary Beneficiary. I hereby appoint the following as my Primary Beneficiary(ies) to receive at my death the amounts credited to my Deferral Account under the Agreement. If I am survived by more than one Primary Beneficiary, such Primary Beneficiaries shall share equally in such amounts unless I indicate otherwise on this form: Name Share Address Relationship5
Primary Beneficiary. The Employee hereby designates the person(s) ------------------- named below to be his primary beneficiary and to receive the balance of any unpaid benefits under the Agreement. ================================================================================ Name of Percentage of Primary Beneficiary Mailing Address Death Benefit -------------------------------------------------------------------------------- % -------------------------------------------------------------------------------- % ================================================================================
Primary Beneficiary. I designate the following persons as my Primary Beneficiary or Beneficiaries to exercise any rights due after my death under the terms of the Award Agreement described at the top of this form. These rights will be allocated, in the proportion specified, to: ______% to _______________________________________________________ (Name) (Relationship) Address: __________________________________________________________ ______% to _______________________________________________________ (Name) (Relationship) Address: __________________________________________________________ ______% to _______________________________________________________ (Name) (Relationship) Address: __________________________________________________________ ______% to _______________________________________________________ (Name) (Relationship) Address: __________________________________________________________
Primary Beneficiary. The Executive hereby designates the person(s) named below to be his primary beneficiary and to receive any distributions that become payable, after the Executive's death, under the Plan: ======================= ===================== ==================== Name of Mailing Address Percentage of Primary Beneficiary Death Benefit ----------------------- --------------------- -------------------- % ----------------------- --------------------- -------------------- % ======================= ===================== ====================
Primary Beneficiary. Name Address Relationship SECONDARY (CONTINGENT) BENEFICIARY: ---------------------- -------------------- ----------------------------- Name Address Relationship THE RIGHT TO REVOKE OR CHANGE ANY BENEFICIARY DESIGNATION IS HEREBY RESERVED. ALL PRIOR DESIGNATIONS, IF ANY, OF PRIMARY BENEFICIARIES AND SECONDARY BENEFICIARIES ARE HEREBY REVOKED.
Primary Beneficiary. I designate the following persons as my Primary Beneficiary or Beneficiaries to receive any shares of DSW stock due after my death under the terms of the Award Agreement described at the top of this form. These shares will be allocated, in the proportion specified to: ______% to _______________________________________________________________ (Name) (Relationship) Address: _________________________________________________________________ ______% to _______________________________________________________________ (Name) (Relationship) Address: _________________________________________________________________ ______% to _______________________________________________________________ (Name) (Relationship) Address: _________________________________________________________________ ______% to _______________________________________________________________ (Name) (Relationship) Address: _________________________________________________________________
Primary Beneficiary. If the Grantee designates more than one Primary Beneficiary and one of the Grantee’s Primary Beneficiaries predeceases him or her, that person’s share will be allocated pro rata to the Grantee’s remaining surviving Primary Beneficiaries. (Please Print) Name and Address Date of Award Agmt # of Option Social Security Number If no Primary Beneficiary survives the Grantee, the Grantee hereby designates the following as Beneficiary. CONTINGENT BENEFICIARY. If the Grantee designates more than one Contingent Beneficiary and one of the Grantee’s Contingent Beneficiaries predeceases him or her, that person’s share will be allocated pro rata to the Grantee’s remaining surviving Contingent Beneficiaries. (Please Print) Name and Address Date of Award Agmt # of Option Social Security Number The Grantee reserves the full right to revoke or modify this designation at any time by filing a subsequent written designation. Any Beneficiary Designation Form is effective only when acknowledged and accepted by a representative of the Company. Upon acknowledgment and acceptance by the Company, all previous Beneficiary Designation Forms are hereby revoked. Grantee’s Name (Printed) Signature of Grantee Date ACKNOWLEDGMENT AND ACCEPTANCE For the Company Date
Primary Beneficiary. The person(s), designated by You, who has the first right to receive the death benefit in the event of death of the Owner, if the date of death is prior to the Maturity Date, provided such person survives the Owner. If more than one Primary Beneficiary is named, each named Beneficiary will share equally in any benefit or rights granted by the Contract, unless You have given Us other Written Notice.
