Form Irabenfm - (Ira) Beneficiary Designation Form Page 2
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23. Beneficiary designation
(continued)
ALL INFORMATION MUST BE COMPLETED.
Spouse
Other
Spouse
Other
Spouse
Other
TOTAL:
Spouse
Other
Spouse
Other
Spouse
Other
TOTAL:
4. Spousal consent
stated in Section 3.
SIGN
Signature of spouse
Date (MM/DD/YYYY)
On
, 20
, before me,
, notary public, personally appeared
Notary’s name
who has satisfactorily identified him/herself as the signer of the above.
Spouse’s name
SIGN
Notary signature
.
5. Signature
SIGN
Signature of owner
Date (MM/DD/YYYY)
6. Mail
Please enclose and mail to:
Regular mail
30 Dan Road
Member FINRA, SIPC
IRABENFM (9/16)
PAGE 2 OF 2
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