Employees' Pension Plan Template printable pdf download

Employees' Pension Plan Template

UNIVERSITY OF NOTRE DAME

Enrollment

EMPLOYEES’ PENSION PLAN

Change

PERSONAL INFORMATION

_____________________________________________________________________________________

Last Name

First

Middle

Date of Birth ____________________________

Social Security Number ___________________________

Spouse’s Name __________________________

Social Security Number ___________________________

DESIGNATION OF BENEFICIARY

If you die before you retire and you do not have five (5) years of vesting service, your contributions

plus interest, if applicable, will be refunded to your beneficiary. If you are legally married and do not

name your spouse as beneficiary, your spouse must sign the consent form. If you do not have five (5)

years of vesting service, your spouse will automatically receive 50% of your reduced benefit in the

form of a Pre-retirement Survivor Benefit (unless the surviving spouse has waived rights). If you are

not married and have five (5) years of vesting service, all contributions plus interest, if applicable, will

be refunded to your beneficiary(ies).

Primary Beneficiary(ies)

Name

Relationship to You

Date of Birth

Social Security Number

Contingent Beneficiary(ies)

Name

Relationship to You

Date of Birth

Social Security Number

I designate the beneficiary(ies) as indicated above.

I have read and I understand the provisions of this application and authorize my employer to deduct from

my earnings the required contributions.

Signed _______________________________________________ Date __________________________

OVER

Employees' Pension Plan Template