401(K) Plan Beneficiary Designation Form
ADVERTISEMENT
1COLORADO PERA
401(k) Plan Beneficiary Designation Form
401(k)
Plan
Voya Financial
Attn: Colorado PERA 401(k) Plan
PO Box 23219
Jacksonville, FL 32241-3219
Fax: 1-888-310-6019
Member
SSN
Participant
Information
Participant Name ________________________________________________________
Date of Birth _____________
Last
First
M.I.
Mailing Address ___________________________________________________________________________________
Street, Route, or Box Number
City
State
ZIP Code
(
)
Home Telephone Number ___________________________ Email Address______________________________________
Employer Name ____________________________________________________________________________________
Employer Mailing Address _____________________________________________________________________________
Street, Route, or Box Number
City
State
ZIP Code
(
)
Work Telephone Number _____________________________________
Beneficiary
Your designation can only be changed by you. Your divorce, annulment or any dissolution or declaration of invalidity of your
Information
marriage SHALL NOT revoke the beneficiary named below as your designated beneficiary unless you revoke the designation by
submitting a new form. Colorado Revised Statute § 15-11-804 does not act to revoke a spouse’s designation as a beneficiary.
To change your existing beneficiary information, please fill in the name and relationship of the individuals you would like to
designate as your future beneficiaries. A primary beneficiary is the person who is your first choice to receive your 401(k) Plan
benefits if you should die. A contingent beneficiary is the person who would receive your 401(k) Plan benefits if your primary
beneficiary should die prior to your death. You may name one or more primary and contingent beneficiaries. Your contingent
beneficiaries will not receive benefits unless all of your primary beneficiaries predecease you.
Name of Primary Beneficiary
Relationship
Social Security Number
Date of Birth
% Payable
______________________________
_____________
_________________
_______________
__________
______________________________
_____________
_________________
_______________
__________
______________________________
_____________
_________________
_______________
__________
______________________________
_____________
_________________
_______________
__________
(Total=100%)
Name of Contingent Beneficiary
Relationship
Social Security Number
Date of Birth
% Payable
______________________________
_____________
_________________
_______________
__________
______________________________
_____________
_________________
_______________
__________
______________________________
_____________
_________________
_______________
__________
______________________________
_____________
_________________
_______________
__________
(Total=100%)
The execution of this form and delivery thereof to Voya Financial for the Colorado PERA 401(k) Plan revokes all prior
Authorization
designations that I have made.
Signature of Participant __________________________________________________
Date ____________________
Please return your completed form to: Voya Financial
Attn: Colorado PERA 401(k) Plan
PO Box 23219
Jacksonville, FL 32241-3219
14-2 (REV 2-15)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal