Capital Credit Beneficiary Assignment

Capital Credit Beneficiary Assignment
Customer Number#
Death of Member
Please complete the beneficiary designation form below by choosing one option for payment of all unretired capital credits associated with this HILCO Electric Cooperative, Inc., Customer Number at the death of the last surviving joint member on the account:
Please complete the beneficiary designation form below by choosing one option for payment:
The Trust uses donations by members through Operation Roundup to fund non-profit organizations in the Cooperative'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

(Option 2) Assignment to a Beneficiary - The Cooperative will not pay capital credits assigned to more than one named surviving beneficiary. The undersigned members assign future Cooperative capital credits paid on this account to the beneficiary named on the most recent beneficiary designation on record when capital credits are retired, either regularly or, at Cooperative's option, at a discount, and as named below:
Beneficiary Name
Beneficiary Address

Street Address

Street Address Line 2

CityState

Zip Code
(Option 3) DEFAULT PAYMENT TO MEMBER’S ESTATE: The Cooperative will pay capital credits to the qualified personal representative or heirs of the member’s 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, which may require probate, and other bylaws and policies will apply.
NOTICE: Unless member chooses Option (1) or (2), the Cooperative will pay capital credits to the member's name or estate under Option (3).
INDEMNITY: THE UNDERSIGNED MEMBERS VERIFY THAT: (1) THEY ARE ALL OF THE MEMBERS ENTITLED TO CAPITAL CREDITS UNDER THIS MEMBER NUMBER, AND (2) MEMBERS UNDERSTAND THAT THE COOPERATIVE WILL RELY ON THE SIGNATURES AND REPRESENTATIONS IN THIS ASSIGNMENT TO PAY

UNDERSIGNED MEMBER'S CAPITAL CREDITS UPON DEATH OF THE MEMBER. BY SIGNING THIS BENEFICIARY ASSIGNMENT, THE UNDERSIGNED MEMBERS HEREBY AGREE, AND BIND THEIR MEMBERS' ESTATES, TO INDEMNIFY AND SAVE HARMLESS HILCO ELECTRIC COOPERATIVE, INC., AND ITS AGENTS AND EMPLOYEES FROM ALL CLAIMS, ACTIONS AND SUITS OF ANY NATURE FROM ANY PERSONAL REPRESENTATIVES, HEIRS OR DEVISEES OF MEMBER RELATING TO PAYMENT OF HILCO ELECTRIC COOPERATIVE'S CAPITAL CREDITS TO THE BENEFICIARIES OF THIS ACCOUNT AS NAMED IN THIS ASSIGNMENT, WITHOUT EXCEPTION.
Member Printed Name

First NameLast Name
Signature
Member Printed Name

First NameLast Name
Signature
INSTRUCTIONS FOR BENEFICIARY DESIGNATION
The Cooperative encourages its members to designate beneficiaries with valid addresses and notify your beneficiaries or personal representatives to contact the Cooperative for capital credits that may be paid after the member's death.

1. Members of HILCO Electric Cooperative, Inc., are owners of the Cooperative which allocates capital credits annually to the accounts of all members. When the Cooperative is financially able, the Cooperative pays (or retires) capital credits to the member's name and address that is listed on the account by check or credit on the member’s account.

2. For up to 30 years, these checks may be mailed to a member who may be deceased at the member's address (or to the beneficiary at the beneficiary’s address) until the Cooperative has proper documents filed showing the member or beneficiary is deceased and proving the identity of the persons entitled to the capital credits.

3. Capital credit checks payable to a member or beneficiary that are not cashed, or checks sent to an undeliverable, incorrect address, may cause the funds to escheat to the State of Texas to be processed as unclaimed funds.

4. To claim capital credits, beneficiaries must present death certificates of the member and any deceased beneficiaries. Unless Cooperative receives a death certificate, a member or beneficiary is presumed to be living.
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Capital Credit Beneficiary Assignment

INSTRUCTIONS FOR BENEFICIARY DESIGNATION