SECONDARY BENEFICIARY. In the event I am not survived by any Primary Beneficiary, I hereby appoint the following as Secondary Beneficiary(ies) to receive death benefits under the Agreement. In the event I am survived by more than one Secondary Beneficiary, such Secondary Beneficiaries shall share equally unless I indicate otherwise on an attachment to this form: ----------------------------------------------------------------- Name Relationship ----------------------------------------------------------------- Address ----------------------------------------------------------------- City State Zip I understand that I may revoke or amend the above designations at any time. I further understand that if I am not survived by a Primary or Secondary Beneficiary, my Beneficiary shall be as set forth under the Agreement.
SECONDARY BENEFICIARY. This Beneficiary Designation hereby revokes any prior Beneficiary Designation which may have been in effect. Such Beneficiary Designation is revocable. DATE: ______________________, 20__ WITNESS DIRECTOR RESTATED DIRECTOR SUPPLEMENTAL RETIREMENT INCOME and DEFERRED COMPENSATION AGREEMENT NOTICE OF ELECTION TO CHANGE FORM OF PAYMENT TO: Bank Attention:
SECONDARY BENEFICIARY. I hereby appoint the following as Secondary Beneficiary(ies) to receive death benefits under the Agreement if none of my Primary Beneficiaries survive me. If I am survived by more than one Secondary Beneficiary, such Secondary Beneficiaries shall share equally unless I indicate otherwise on this form: Name Share Address Relationship5 [continued on next page] 4 A Trustee may designate any person or a Trust as a Beneficiary. 5 For aid in identification only. I understand that (i) if none of my Primary or Secondary Beneficiaries survive me then payment will be made to my estate; and (ii) if I do not properly designate a Beneficiary, under the Agreement, I will be deemed to have designated my estate as my Primary Beneficiary. I understand that I may revoke or amend the above designations at any time. I further understand that if I am not survived by a Primary or Secondary Beneficiary, my Beneficiary shall be as set forth under the Agreement. Dated:
SECONDARY BENEFICIARY. This Beneficiary Designation hereby revokes any prior Beneficiary Designation which may have been in effect. Such Beneficiary Designation is revocable. DATE: ______________________, 20__ (WITNESS) DIRECTOR (WITNESS Exhibit B EXECUTIVE SUPPLEMENTAL RETIREMENT INCOME AGREEMENT NOTICE OF ELECTION TO CHANGE FORM OF PAYMENT TO: Bank Attention: I hereby give notice of my election to change the form of payment of my Supplemental Retirement Income Benefit, as specified below. I understand that such notice, in order to be effective, must be submitted in accordance with the time requirements described in Subsection 1.25 of my Executive Supplemental Retirement Income Agreement. G I hereby elect to change the form of payment of my benefits from monthly installments throughout my Payout Period to a lump sum benefit payment. G I hereby elect to change the form of payment of my benefits from a lump sum benefit payment to monthly installments throughout my Payout Period. Such election hereby revokes my previous notice of election to receive a lump sum form of benefit payments. Executive Date Acknowledged By: Title: Date:
SECONDARY BENEFICIARY. This Beneficiary Designation hereby revokes any prior Beneficiary Designation which may have been in effect. Such Beneficiary Designation is revocable. DATE: ______________________, 19____ ----------------------------------- ------------------------------ (WITNESS) EXECUTIVE ----------------------------------- (WITNESS) Exhibit B EXECUTIVE SUPPLEMENTAL RETIREMENT INCOME AGREEMENT NOTICE OF ELECTION TO CHANGE FORM OF PAYMENT TO: Bank Attention: I hereby give notice of my election to change the form of payment of my Supplemental Retirement Income Benefit, as specified below. I understand that such notice, in order to be effective, must be submitted in accordance with the time requirements described in my Executive Supplemental Retirement Income Agreement. o I hereby elect to change the form of payment of my benefits from monthly installments throughout my Payout Period to a lump sum benefit payment. o I hereby elect to change the form of payment of my benefits from a lump sum benefit payment to monthly installments throughout my Payout Period. Such election hereby revokes my previous notice of election to receive a lump sum form of benefit payments. Executive Date Acknowledged By: Title: Date Exhibit C CONDITIONS, ASSUMPTIONS, AND SCHEDULE OF CONTRIBUTIONS AND PHANTOM CONTRIBUTIONS FOR THOMAS C. GREGOR
SECONDARY BENEFICIARY. This Beneficiary Designation hereby revokes any prior Beneficiary Designation which may have been in effect. Such Beneficiary Designation is revocable. DATE: ______________________, 20__ WITNESS EXECUTIVE First Amendment to the
SECONDARY BENEFICIARY. I hereby appoint the following as Secondary Beneficiary(ies) to receive death benefits under the Agreement if none of my Primary Beneficiaries survive me. If I am survived by more than one Secondary Beneficiary, such Secondary Beneficiaries shall share equally unless I indicate otherwise on this form: Name Share Address Relationship5 [continued on next page]
SECONDARY BENEFICIARY. This Beneficiary Designation hereby revokes any prior Beneficiary Designation which may have been in effect. Such Beneficiary Designation is revocable. DATE: ______________________, 20__ WITNESS DIRECTOR RESTATED DIRECTOR SUPPLEMENTAL RETIREMENT INCOME and DEFERRED COMPENSATION AGREEMENT NOTICE OF ELECTION TO CHANGE FORM OF PAYMENT TO: Bank Attention: I hereby give notice of my election to change the form of payment of my Supplemental Retirement Income Benefit, as specified below. I understand that such notice, in order to be effective, must be submitted in accordance with the time requirements described in Subsection 1.27 of my Restated Director Supplemental Retirement Income and Deferred Compensation Agreement. G I hereby elect to change the form of payment of my benefits from monthly installments throughout my Payout Period to a lump sum benefit payment. G I hereby elect to change the form of payment of my benefits from a lump sum benefit payment to monthly installments throughout my Payout Period. Such election hereby revokes my previous notice of election to receive a lump sum form of benefit payments. DIRECTOR DATE ACKNOWLEDGED BY: TITLE: DATE RESTATED DIRECTOR SUPPLEMENTAL RETIREMENT INCOME and DEFERRED COMPENSATION AGREEMENT NOTICE OF ADJUSTMENT OF ELECTIVE CONTRIBUTION TO: Bank Attention: I hereby give notice of my election to adjust the amount of my Elective Contribution in accordance with my Restated Director Supplemental Retirement Income and Deferred Compensation Agreement, dated the 1st day of February, 2004, as amended and restated effective January 1, 2006. This notice is submitted thirty (30) days prior to January 1st, and shall become effective January 1st, as specified below. Adjust deferral as of: January 1st, 2___ Previous Deferral Amount ____________ per month New Deferral Amount ____________ per month (to discontinue deferral, enter $0) DIRECTOR DATE ACKNOWLEDGED BY TITLE DATE
SECONDARY BENEFICIARY. In the event I am not survived by any Primary Beneficiary, I hereby appoint the following as Secondary Beneficiary(ies) to receive death benefits under the Agreement. In the event I am survived by more than one Secondary Beneficiary, such Secondary Beneficiaries shall share equally unless I indicate otherwise on an attachment to this form: Name Relationship Address City State Zip I understand that I may revoke or amend the above designations at any time. I further understand that if I am not survived by any Primary or Secondary Beneficiary, my Beneficiary shall be as set forth under the Agreement.
SECONDARY BENEFICIARY. In the event I am not survived by any Primary Beneficiary, I hereby appoint the following as my Secondary Beneficiary(ies) to receive death benefits under the Agreement. In the event I am survived by more than one Secondary Beneficiary, such Secondary Beneficiaries shall share equally unless I indicate otherwise on an attachment to this form: Name Relationship Address City State Zip I understand that I may revoke or amend the above designations at any time. I further understand that if I am not survived by a Primary or Secondary Beneficiary, my Beneficiary shall be as set forth under the Agreement. TRUSTEE Signature: Print Name: Date: THE FUNDS Signature: Print Name of Officer: Date:
