Form Dc-770-0113 - Nationwide Beneficiary Change Form (Page 2 of 2) in pdf

Form Dc-770-0113 - Nationwide Beneficiary Change Form Page 2

Model Beneficiary Designations

Please use the following designations as a guide when completing this form.

Joan Nation, spouse (Primary).

Joan Nation, spouse (Primary), Henry Nation, son (Contingent).

Joan Nation, spouse (Primary), Henry Nation and Betty Nation, children (Contingent).

Henry Nation and Betty Nation, children (Primary).

Henry Nation, John Nation, and Betty Nation, children (Primary).

Sara Nation, mother, and George Nation, father (Primary), Jean Nation, sister (Contingent).

Estate. (Requires certified copy of “Letters of Office” appointing an executor of the Estate).

First National Bank of Canton, Ohio, as Trustee under Trust Agreement with Robert E. Nation dated

January 1, 2002. (Attach a copy of the title and signature page of the Trust).

Generic beneficiary designations will not be accepted. Examples of generic designations

include:

My spouse, parent(s), sister(s), brother(s), son(s), daughter(s).

My children.

Children of this marriage or any past marriage.

As designated in my will.

Mail completed form to:

Nationwide Retirement Solutions

P.O. Box 182797

Columbus, Ohio 43218-2797

DC-770-0113

Form Dc-770-0113 - Nationwide Beneficiary Change Form Page 2