Capital Credit Beneficiary Assignment

Capital Credit Beneficiary Assignment
Customer Number #
Please complete the beneficiary designation form below by choosing one option for payment of all unretired capital credits associated with my/our HILCO Electric Cooperative, Inc., Customer Number at the death of the last surviving joint member:
I/We are the all members entitled to capital credits under this Customer Number. Members hereby indemnify and save harmless said Cooperative from all claims, actions and suits from any personal representatives, heirs or devisees, and name these beneficiaries of my/our account, as follows:
Option 1 - Assignment to the HILCO Electric Trust - The undersigned assigns future capital credits paid on my/our account to the HILCO Electric Trust ("Trust") when capital credits are retired either regularly or, at Cooperative's option, at a discount. The Trust uses donations by members through Operation Roundup to fund non-profit organizations in HILCO's service area. Operation Roundup is a voluntary program in which members allow HILCO to "round-up" their monthly bills to the nearest dollar to provide this funding. OR
Beneficiary Name
Beneficiary Address

Street Address

Street Address Line 2

CityState

Zip Code
Relationship
Undersigned cancels all claims of my estate or heirs to Capital Credits in favor of the above-named beneficiary. OR
Note – Unless member chooses Option (1) or (2), Cooperative will pay to the member’s name or under Option (3).
Applicant
Signature
Date

MeseGiornoAnno
2 digit month, 2 digit day, 4 digit yearDate
Co-Applicant
Signature
Date

MeseGiornoAnno
2 digit month, 2 digit day, 4 digit yearDate

INSTRUCTIONS FOR BENEFICIARY DESIGNATION
Members of HILCO Electric Cooperative, Inc., are owners of the Cooperative. Cooperative Board of Directors allocates capital credits annually to the accounts of all members. When the Cooperative is financially able, Cooperative pays (or retires) capital credits to member's name and at the address that is listed on the account.

These checks will continue to be mailed to the deceased member at the member's address until the Cooperative has proper documents filed showing the member is deceased and proving the identity of the persons entitled to the capital credits.

Capital credit checks payable to a deceased member that are not cashed, or checks sent to an undeliverable, incorrect address may result in the funds escheating to the State of Texas as unclaimed funds. The Cooperative encourages its members to designate beneficiaries for capital credits that may be paid after the member's death.
Option 1 - The member can choose to designate the HILCO Electric Trust as beneficiary. The capital credit funds will be donated to charity non-profit organizations located in the territory that HILCO Cooperative serves.
Option 2 - For payments scheduled and paid after Cooperative is properly notified that a member is deceased, the Cooperative will transfer capital credits to a joint member, if any, or pay capital credits according to to:

(1) The most recent beneficiary designation on record, or

(2) To the qualified personal representative or heirs of the estate who has complied with the policies and bylaws of Cooperative. If Cooperative is notified that a member is deceased, and the member did not designate a beneficiary, CAPITAL CREDIT SPECIAL RETIREMENT APPLICATION FOR DECEASED MEMBERS, GENERAL POLICY 205, and other bylaws and policies will apply.
Option 3 - The member understands that failure to assign and keep current at least one surviving beneficiary with a valid address may result in Capital Credit retirement checks being unclaimed and processed by the State of Texas and Cooperative as unclaimed funds
To claim capital credits, beneficiaries must present death certificates of the member and any deceased beneficiaries. Checks will be paid to the name and address of the surviving beneficiaries on the account. Unless Cooperative receives a death certificate, a member or beneficiary is presumed to be living. Please notify your beneficiaries or personal representatives to contact Cooperative.
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Capital Credit Beneficiary Assignment

INSTRUCTIONS FOR BENEFICIARY DESIGNATION