Beneficiary Application Form (Publishing)

Beneficiary Application Form

Please use this form to notify Reservoir Media Management, Inc. of the deceased royalty recipient and/or songwriter for whom you are seeking to establish a beneficiary account(s).
- If you do not know the answer to an applicable question, write "Unknown".
- If you need more room to answer a question or explain the status of the decedent's estate, please attach a separate sheet in the Document Upload Portal found in Section VI., and label the sheet according to the section and question that your answer corresponds with.
- If you have any legal questions regarding the completion of this form, please consult an attorney. Reservoir Media Management, Inc. is unauthorized to provide legal advice on these matters.
- For non-legal questions about completing this form, please contact Reservoir Media Management, Inc:
Email: royalties@reservoir-media.com

Phone: (212) 675-0541

Section I. Contact Information
Section I. Contact Information
Name of person completing form: *

First NameLast Name
Email:*
example@example.com
Phone Number:*
Please enter a valid phone number.
Relation to the decedent or their estate:*
Example: "Sister" or " Estate's Lawyer"

Section II. Decedent's Information
Section II. Decedent's Information

Please complete this section using the requested information of the deceased royalty recipient and/or songwriter.
1. Decedent's Name:*

First NameLast Name
2. Decedent's Client Code Number:
Decedent's Client Code Number can be found on their royalty statement, next to their name. Example: Jamie Smith (1234)
3. If the decedent is not the original songwriter, please indicate the original songwriter from whom the royalty interests are received:

First NameLast Name

Section III. Decedent's Estate Information
Section III. Decedent's Estate Information
1. Did the decedent leave a will?*
IF "YES", SEE SECTION VI. - DOCUMENTATION REQUIREMENT.
2. Did the decedent's will or estate go through probate?*
IF "YES", SEE SECTION VI. - DOCUMENTATION REQUIREMENT.
**If the decedent's will or estate has been probated, please complete all of Section III. Otherwise, proceed to Section IV.**
3. Decedent's Estate Name:
4. Estate Tax Identification Number:
Example: 12-3456789
5. Name of Executor or Administrator for Decedent's Estate:

First NameLast Name
6. Executor's or Administrator's Email:
example@example.com
7. Executor's or Administrator's Phone Number:
Please enter a valid phone number.
8. Name of Decedent's Estate Attorney (if applicable):

First NameLast Name
9. Attorney's Email (if applicable):
example@example.com
10. Attorney's Phone Number (if applicable):
Please enter a valid phone number.
11. Has the decedent's estate been closed?
12. If YES, please provide the date it closed:

MonthDayYear
13. Was an order of distribution issued by a probate court?
IF "YES", SEE SECTION VI. - DOCUMENTATION REQUIREMENT.

Section IV. Beneficiary Information
Section IV. Beneficiary Information

Please provide the information requested for any individual(s) entitled to a share of the decedent's royalty interest.
Consider the following when completing this section:
- If a beneficiary is under the age of 18, please provide the requested contact information of their legal guardian.
- If there are multiple beneficiaries, the shares of the decedent's royalty interest designated to each individual beneficiary must reflect that to which they are entitled in the decedent's will, probate documents, or any other legally binding estate documentation. The royalty interest entitled to the individual beneficiaries combined must equal 100%.
- If the decedent left all or a portion of their royalty interest to a trust, please provide that information in Section V.
- If there are more than three (3) beneficiaries, please provide the beneficiary information requested below for the additional beneficiaries on a separate document and submit it as a pdf file using the Document Upload Portal located in Section VI of this application.
Beneficiary (1)
1. Beneficiary's Name:

First NameLast Name
2. Beneficiary's Date of Birth:

MonthDayYear
3. If the beneficiary is under 18 years old, please provide the name of their legal guardian:

First NameLast Name
4. Beneficiary's Email:
Provide guardian's email If the beneficiary is under 18 years old. example@example.com
5 .Beneficiary's Phone Number:
Provide guardian's phone number if the beneficiary is under 18 years old.
6. Percentage of the decedent's royalty interest entitled to this beneficiary:
Example: 50%
Beneficiary (2)
1. Beneficiary's Name:

First NameLast Name
2. Beneficiary's Date of Birth:

MonthDayYear
3. If the beneficiary is under 18 years old, please provide the name of their legal guardian:

First NameLast Name
4. Beneficiary's Email:
Provide guardian's email If the beneficiary is under 18 years old. example@example.com
5. Beneficiary's Phone Number:
Provide guardian's phone number if the beneficiary is under 18 years old.
6. Percentage of the decedent's royalty interest entitled to this beneficiary:
Example: 50%
Beneficiary (3)
1. Beneficiary's Name:

First NameLast Name
2. Beneficiary's Date of Birth:

MonthDayYear
3. If the beneficiary is under 18 years old, please provide the name of their legal guardian:

First NameLast Name
4. Beneficiary's Email:
Provide guardian's email If the beneficiary is under 18 years old. example@example.com
5. Beneficiary's Phone Number:
Provide guardian's phone number if the beneficiary is under 18 years old.
6. Percentage of the decedent's royalty interest entitled to this beneficiary:
Example: 50%

Section V. Beneficiary Trust Information
Section V. Beneficiary Trust Information

Please complete this section if the decedent left a share of their royalty interest to a trust. Otherwise, proceed to Section VI.
1. Name of Beneficiary Trust:
DOCUMENTATION REQUIREMENT - SEE SECTION VI.
2. Name of Beneficiary Trustee:

First NameLast Name
3. Beneficiary Trustee's Email:
example@example.com
4. Beneficiary Trustee's Phone Number:
Please enter a valid phone number.
5. Percentage of the decedent's royalty interest entitled to this beneficiary:
Example: 50%

Section VI. Required Documents
Section VI. Required Documents

Where applicable, please provide the following documents with the submission of this application to Reservoir Media Management, Inc:
- A copy of the decedent's death certificate.
- If the decedent left a will, a copy of the decedent's last will and testament and codicils.
- If the decedent's will or estate was probated, a copy of the letters testamentary or letters of administration that were issued by the probate court
- If an order of distribution was issued by a probate court, a copy of the order of distribution or final accounting.
- If there are additional beneficiaries not already listed in Section IV or Section V, provide the information requested in those sections for each additional beneficiary on a separate document and submit it here.
- If a trust is entitled to any share of the decedent's royalty interest, a copy of the full document creating the trust and any amendments to or restatements of the trust created to date.
All documents can be submitted through the Document Upload Portal below.
Document Upload Portal

Cancelof

Section VII. Declaration
Section VII. Declaration
I declare under penalty of perjury that, to the best of my knowledge and belief, the foregoing information is true and all questions have been answered fully and completely and without any intent to deceive Reservoir Media Management, Inc. with respect to the facts concerning the decedent, their estate, and/or their lawful beneficiaries.

Reservoir Media Management, Inc. reserves the right to withhold payment of royalties to all beneficiaries entered into Section IV or Section V of this form if any information provided through the beneficiary application process is inconsistent with or acts contrary to the legally bound provisions of the decedent’s estate, or if the information supplied on behalf of the decedent's estate is insufficient to the point that Reservoir Media Management, Inc. is unable to verify the rightful beneficiaries to those royalties.
I agree to these terms*
Should be Empty:

Section I. Contact Information

Section II. Decedent's Information

Section III. Decedent's Estate Information

**If the decedent's will or estate has been probated, please complete all of Section III. Otherwise, proceed to Section IV.**

Section IV. Beneficiary Information

Section V. Beneficiary Trust Information

Section VII. Declaration

If the decedent's will or estate has been probated, please complete all of Section III. Otherwise, proceed to Section IV.