Beneficiary Designation
Thank you for designating your beneficiary or beneficiaries. Please complete information about each beneficiary below.
Account Owner Name
*
First Name
Middle Name
Last Name
Account Owner Email
*
someone@example.com
Account Owner Primary Phone Number
Please enter a valid phone number.
Number of Primary Beneficiaries I Wish To Designate:
Number of Primary Beneficiaries
Our online beneficiary designation system supports up to six (6) primary and/or contingent beneficiary designations. If you have more than six (6) primary or contingent beneficiaries, please submit this form multiple times.
Primary Beneficiary Percent
Lineal Descendent Per Stirpes?
Lineal Descendent Per Stirpes
If desired, you may include the instruction “Lineal Descendants Per Stirpes” or “LDPS” next to any beneficiary name, in which case any entitled portion will pass to that beneficiary’s lineal descendants in the event he/she predeceases you.
Primary Beneficiary Relationship
Beneficiary Relationship
Spouse
Civil Union
Common Law Marriage
Domestic Partnership
Child
Step Child
Sibling
Parent
Grandchild
Grandparent
Mother-in-law
Father-in-law
Sister-in-law
Brother-in-law
Son-in-law
Co-worker
Neighbor
Estate
Trust Beneficiary
Trust Grantor
Trustee
Other
Select Beneficiary Relationship
Name of Primary Beneficiary
First Name
Middle Name
Last Name
Primary Beneficiary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Beneficiary Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Primary Beneficiary Social Security Number
Primary Beneficiary Phone Number
Please enter a valid phone number.
Beneficiary Email
someone@example.com
Primary Beneficiary Percent
Lineal Descendent Per Stirpes?
Lineal Descendent Per Stirpes
If desired, you may include the instruction “Lineal Descendants Per Stirpes” or “LDPS” next to any beneficiary name, in which case any entitled portion will pass to that beneficiary’s lineal descendants in the event he/she predeceases you.
Primary Beneficiary Relationship
Beneficiary Relationship
Spouse
Civil Union
Common Law Marriage
Domestic Partnership
Child
Step Child
Sibling
Parent
Grandchild
Grandparent
Mother-in-law
Father-in-law
Sister-in-law
Brother-in-law
Son-in-law
Co-worker
Neighbor
Estate
Trust Beneficiary
Trust Grantor
Trustee
Other
Select Beneficiary Relationship
Name of Primary Beneficiary
First Name
Middle Name
Last Name
Primary Beneficiary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Beneficiary Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Primary Beneficiary Social Security Number
Primary Beneficiary Phone Number
Please enter a valid phone number.
Beneficiary Email
someone@example.com
Primary Beneficiary Percent
Lineal Descendent Per Stirpes?
Lineal Descendent Per Stirpes
If desired, you may include the instruction “Lineal Descendants Per Stirpes” or “LDPS” next to any beneficiary name, in which case any entitled portion will pass to that beneficiary’s lineal descendants in the event he/she predeceases you.
Primary Beneficiary Relationship
Beneficiary Relationship
Spouse
Civil Union
Common Law Marriage
Domestic Partnership
Child
Step Child
Sibling
Parent
Grandchild
Grandparent
Mother-in-law
Father-in-law
Sister-in-law
Brother-in-law
Son-in-law
Co-worker
Neighbor
Estate
Trust Beneficiary
Trust Grantor
Trustee
Other
Select Beneficiary Relationship
Name of Primary Beneficiary
First Name
Middle Name
Last Name
Primary Beneficiary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Beneficiary Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Primary Beneficiary Social Security Number
Primary Beneficiary Phone Number
Please enter a valid phone number.
Beneficiary Email
someone@example.com
Primary Beneficiary Percent
Lineal Descendent Per Stirpes?
Lineal Descendent Per Stirpes
If desired, you may include the instruction “Lineal Descendants Per Stirpes” or “LDPS” next to any beneficiary name, in which case any entitled portion will pass to that beneficiary’s lineal descendants in the event he/she predeceases you.
Primary Beneficiary Relationship
Beneficiary Relationship
Spouse
Civil Union
Common Law Marriage
Domestic Partnership
Child
Step Child
Sibling
Parent
Grandchild
Grandparent
Mother-in-law
Father-in-law
Sister-in-law
Brother-in-law
Son-in-law
Co-worker
Neighbor
Estate
Trust Beneficiary
Trust Grantor
Trustee
Other
Select Beneficiary Relationship
Name of Primary Beneficiary
First Name
Middle Name
Last Name
Primary Beneficiary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Beneficiary Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Primary Beneficiary Social Security Number
Primary Beneficiary Phone Number
Please enter a valid phone number.
Beneficiary Email
someone@example.com
Primary Beneficiary Percent
Lineal Descendent Per Stirpes?
Lineal Descendent Per Stirpes
If desired, you may include the instruction “Lineal Descendants Per Stirpes” or “LDPS” next to any beneficiary name, in which case any entitled portion will pass to that beneficiary’s lineal descendants in the event he/she predeceases you.
Primary Beneficiary Relationship
Beneficiary Relationship
Spouse
Civil Union
Common Law Marriage
Domestic Partnership
Child
Step Child
Sibling
Parent
Grandchild
Grandparent
Mother-in-law
Father-in-law
Sister-in-law
Brother-in-law
Son-in-law
Co-worker
Neighbor
Estate
Trust Beneficiary
Trust Grantor
Trustee
Other
Select Beneficiary Relationship
Name of Primary Beneficiary
First Name
Middle Name
Last Name
Primary Beneficiary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Beneficiary Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Primary Beneficiary Social Security Number
Primary Beneficiary Phone Number
Please enter a valid phone number.
Beneficiary Email
someone@example.com
Primary Beneficiary Percent
Lineal Descendent Per Stirpes?
Lineal Descendent Per Stirpes
If desired, you may include the instruction “Lineal Descendants Per Stirpes” or “LDPS” next to any beneficiary name, in which case any entitled portion will pass to that beneficiary’s lineal descendants in the event he/she predeceases you.
Primary Beneficiary Relationship
Beneficiary Relationship
Spouse
Civil Union
Common Law Marriage
Domestic Partnership
Child
Step Child
Sibling
Parent
Grandchild
Grandparent
Mother-in-law
Father-in-law
Sister-in-law
Brother-in-law
Son-in-law
Co-worker
Neighbor
Estate
Trust Beneficiary
Trust Grantor
Trustee
Other
Select Beneficiary Relationship
Name of Primary Beneficiary
First Name
Middle Name
Last Name
Primary Beneficiary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Beneficiary Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Primary Beneficiary Social Security Number
Primary Beneficiary Phone Number
Please enter a valid phone number.
Beneficiary Email
someone@example.com
Total Primary Beneficiary Designation
Your Primary Beneficiary Designations Add Up To 100%!
Your Primary Beneficiary Designations Do Not Add Up To 100%! Please Edit Your Beneficiary Percentages!
Do You Wish To Designate Contingent Beneficiary or Beneficiaries?
Yes
No
Number of Contingent Beneficiaries I Wish To Designate:
Number of Contingent Beneficiaries
Our online beneficiary designation system supports up to six (6) primary and/or contingent beneficiary designations. If you have more than six (6) primary or contingent beneficiaries, please submit this form multiple times.
Contingent Beneficiary Percent
Lineal Descendent Per Stirpes?
Lineal Descendent Per Stirpes
If desired, you may include the instruction “Lineal Descendants Per Stirpes” or “LDPS” next to any beneficiary name, in which case any entitled portion will pass to that beneficiary’s lineal descendants in the event he/she predeceases you.
Contingent Beneficiary Relationship
Beneficiary Relationship
Spouse
Civil Union
Common Law Marriage
Domestic Partnership
Child
Step Child
Sibling
Parent
Grandchild
Grandparent
Mother-in-law
Father-in-law
Sister-in-law
Brother-in-law
Son-in-law
Co-worker
Neighbor
Estate
Trust Beneficiary
Trust Grantor
Trustee
Other
Select Beneficiary Relationship
Name of Contingent Beneficiary
First Name
Middle Name
Last Name
Contingent Beneficiary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contingent Beneficiary Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Contingent Beneficiary Social Security Number
Contingent Beneficiary Phone Number
Please enter a valid phone number.
Contingent Beneficiary Email
someone@example.com
Contingent Beneficiary Percent
Lineal Descendent Per Stirpes?
Lineal Descendent Per Stirpes
If desired, you may include the instruction “Lineal Descendants Per Stirpes” or “LDPS” next to any beneficiary name, in which case any entitled portion will pass to that beneficiary’s lineal descendants in the event he/she predeceases you.
Contingent Beneficiary Relationship
Beneficiary Relationship
Spouse
Civil Union
Common Law Marriage
Domestic Partnership
Child
Step Child
Sibling
Parent
Grandchild
Grandparent
Mother-in-law
Father-in-law
Sister-in-law
Brother-in-law
Son-in-law
Co-worker
Neighbor
Estate
Trust Beneficiary
Trust Grantor
Trustee
Other
Select Beneficiary Relationship
Name of Contingent Beneficiary
First Name
Middle Name
Last Name
Contingent Beneficiary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contingent Beneficiary Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Contingent Beneficiary Social Security Number
Contingent Beneficiary Phone Number
Please enter a valid phone number.
Contingent Beneficiary Email
someone@example.com
Contingent Beneficiary Percent
Lineal Descendent Per Stirpes?
Lineal Descendent Per Stirpes
If desired, you may include the instruction “Lineal Descendants Per Stirpes” or “LDPS” next to any beneficiary name, in which case any entitled portion will pass to that beneficiary’s lineal descendants in the event he/she predeceases you.
Contingent Beneficiary Relationship
Beneficiary Relationship
Spouse
Civil Union
Common Law Marriage
Domestic Partnership
Child
Step Child
Sibling
Parent
Grandchild
Grandparent
Mother-in-law
Father-in-law
Sister-in-law
Brother-in-law
Son-in-law
Co-worker
Neighbor
Estate
Trust Beneficiary
Trust Grantor
Trustee
Other
Select Beneficiary Relationship
Name of Contingent Beneficiary
First Name
Middle Name
Last Name
Contingent Beneficiary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contingent Beneficiary Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Contingent Beneficiary Social Security Number
Contingent Beneficiary Phone Number
Please enter a valid phone number.
Contingent Beneficiary Email
someone@example.com
Contingent Beneficiary Percent
Lineal Descendent Per Stirpes?
Lineal Descendent Per Stirpes
If desired, you may include the instruction “Lineal Descendants Per Stirpes” or “LDPS” next to any beneficiary name, in which case any entitled portion will pass to that beneficiary’s lineal descendants in the event he/she predeceases you.
Contingent Beneficiary Relationship
Beneficiary Relationship
Spouse
Civil Union
Common Law Marriage
Domestic Partnership
Child
Step Child
Sibling
Parent
Grandchild
Grandparent
Mother-in-law
Father-in-law
Sister-in-law
Brother-in-law
Son-in-law
Co-worker
Neighbor
Estate
Trust Beneficiary
Trust Grantor
Trustee
Other
Select Beneficiary Relationship
Name of Contingent Beneficiary
First Name
Middle Name
Last Name
Contingent Beneficiary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contingent Beneficiary Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Contingent Beneficiary Social Security Number
Contingent Beneficiary Phone Number
Please enter a valid phone number.
Contingent Beneficiary Email
someone@example.com
Contingent Beneficiary Percent
Lineal Descendent Per Stirpes?
Lineal Descendent Per Stirpes
If desired, you may include the instruction “Lineal Descendants Per Stirpes” or “LDPS” next to any beneficiary name, in which case any entitled portion will pass to that beneficiary’s lineal descendants in the event he/she predeceases you.
Contingent Beneficiary Relationship
Beneficiary Relationship
Spouse
Civil Union
Common Law Marriage
Domestic Partnership
Child
Step Child
Sibling
Parent
Grandchild
Grandparent
Mother-in-law
Father-in-law
Sister-in-law
Brother-in-law
Son-in-law
Co-worker
Neighbor
Estate
Trust Beneficiary
Trust Grantor
Trustee
Other
Select Beneficiary Relationship
Name of Contingent Beneficiary
First Name
Middle Name
Last Name
Contingent Beneficiary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contingent Beneficiary Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Contingent Beneficiary Social Security Number
Contingent Beneficiary Phone Number
Please enter a valid phone number.
Contingent Beneficiary Email
someone@example.com
Contingent Beneficiary Percent
Lineal Descendent Per Stirpes?
Lineal Descendent Per Stirpes
If desired, you may include the instruction “Lineal Descendants Per Stirpes” or “LDPS” next to any beneficiary name, in which case any entitled portion will pass to that beneficiary’s lineal descendants in the event he/she predeceases you.
Contingent Beneficiary Relationship
Beneficiary Relationship
Spouse
Civil Union
Common Law Marriage
Domestic Partnership
Child
Step Child
Sibling
Parent
Grandchild
Grandparent
Mother-in-law
Father-in-law
Sister-in-law
Brother-in-law
Son-in-law
Co-worker
Neighbor
Estate
Trust Beneficiary
Trust Grantor
Trustee
Other
Select Beneficiary Relationship
Name of Contingent Beneficiary
First Name
Middle Name
Last Name
Contingent Beneficiary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contingent Beneficiary Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Contingent Beneficiary Social Security Number
Contingent Beneficiary Phone Number
Please enter a valid phone number.
Contingent Beneficiary Email
someone@example.com
Total Contingent Beneficiary Designation
Your Contingent Beneficiary Designations Add Up To 100%!
Your Contingent Beneficiary Designations Do Not Add Up To 100%! Please edit your Contingent Beneficiary Percentages!
Submit
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