Sbs/select Benefits Beneficiary Form Instructions

ADVERTISEMENT

SBS/SELECT BENEFITS BENEFICIAR
SBS/SELECT BENEFITS BENEFICIAR
SBS/SELECT BENEFITS BENEFICIARY FORM INSTR
Y FORM INSTR
Y FORM INSTR
Y FORM INSTRUCTIONS
UCTIONS
UCTIONS
UCTIONS
SBS/SELECT BENEFITS BENEFICIAR
SBS/SELECT BENEFITS BENEFICIAR
Y FORM INSTR
UCTIONS
This form names the people you want to receive any benefits you may have elected in the event of your death. It may also be used to change those
names at any time. You are responsible for this form being received by the Division of Retirement and Benefits. Bring or mail this completed
form directly to this office.
SECTION ONE: PERSONAL DATA
SECTION ONE: PERSONAL DATA
SECTION ONE: PERSONAL DATA
SECTION ONE: PERSONAL DATA
SECTION ONE: PERSONAL DATA
Complete this section each time you use this form.
SECTION TWO: BENEFICIARY DESIGNATION
SECTION TWO: BENEFICIARY DESIGNATION
SECTION TWO: BENEFICIARY DESIGNATION
SECTION TWO: BENEFICIARY DESIGNATION
SECTION TWO: BENEFICIARY DESIGNATION
This section has space for up to six beneficiaries. If necessary, attach additional forms. This section must be completed listing all intended beneficiaries
each time this form is used.
IMPORTANT
IMPORTANT
IMPORTANT
IMPORTANT
IMPORTANT
Annuity Beneficiaries: The beneficiary of your SBS Annuity Account is the person who will receive your account balance should you die before
you receive payment of this account.
If you are married, your spouse must be the beneficiary for at least 50% of your annuity account. If you list any person other than your spouse
for more than 50% of your SBS Annuity, you must complete an Annuity Beneficiary Waiver showing your spouse's consent. Without your spouse's
consent, any beneficiary designation over 50% to a nonspouse is invalid. The Annuity Beneficiary Waiver form is available from the SBS office.
You may list any person as beneficiary for your SBS death benefits.
8. - 14.
Enter the beneficiary's name, address and relationship to you.
15.
Indicate which benefits this beneficiary should receive if you die. Only check those programs in which you have enrolled.
Remember, each employee has an annuity account.
16.
Indicate whether this beneficiary is primary or contingent. Primary beneficiaries receive the benefit first if you die.
Contingent beneficiaries receive the benefit if the primary beneficiary has died.
17.
Indicate the percentage of the benefits that you would like this beneficiary to receive. The total percentage given to
primary beneficiaries must equal 100%. The total percentage given to contingent beneficiaries must equal 100%.
18. - 67.
List as many beneficiaries as you like, following the instructions for the first beneficiary in #8 through #17 above.
EXAMPLES
EXAMPLES
EXAMPLES
EXAMPLES
EXAMPLES
Jane Doe is married with no children. She has enrolled in life insurance and, like all employees, has an annuity account. She wishes her husband
to receive these benefits if she dies:
. . . . .
. . . . .
BENEFICIARY
BENEFICIARY
BENEFICIARY LAST
LAST
LAST NAME
LAST
NAME
NAME
NAME
FIRST
FIRST
FIRST NAME
NAME
NAME
NAME
M M M M M
I I I I I
RELATIONSHIP
RELATIONSHIP
RELATIONSHIP
BENEFICIARY
BENEFICIARY
LAST
NAME
FIRST
FIRST
NAME
RELATIONSHIP
RELATIONSHIP
Doe
John
K.
Husband
MAILING
MAILING
MAILING
MAILING
MAILING ADDRESS
ADDRESS
ADDRESS
ADDRESS
ADDRESS
CITY
CITY
CITY
CITY
CITY AND
AND
AND
AND
AND STATE
STATE
STATE
STATE
STATE
ZIP
ZIP
ZIP
ZIP
ZIP CODE
CODE
CODE
CODE
CODE
1000 Any Street
Anytown, AK
99999
: : : : :
: : : : :
I I I I I WANT
WANT
WANT
WANT
WANT THIS
THIS
THIS
THIS
THIS BENEFICIARY
BENEFICIARY
BENEFICIARY
BENEFICIARY
BENEFICIARY TO
TO
TO
TO
TO RECEIVE
RECEIVE
RECEIVE
RECEIVE
RECEIVE THE
THE
THE
THE
THE FOLLOWING
FOLLOWING
FOLLOWING
FOLLOWING
FOLLOWING BENEFITS
BENEFITS
BENEFITS
BENEFITS IF IF IF IF IF I I I I I DIE
BENEFITS
DIE
DIE
DIE
DIE
I I I I I WANT
WANT
WANT
WANT
WANT THIS
THIS
THIS
THIS
THIS BENEFICIARY
BENEFICIARY
BENEFICIARY
BENEFICIARY
BENEFICIARY TO
TO
TO
TO
TO BE
BE
BE
BE
BE
I I I I I WANT
WANT
WANT
THIS
THIS
BENEFICIARY
BENEFICIARY
TO
TO
WANT
WANT THIS
THIS
THIS BENEFICIARY
BENEFICIARY
BENEFICIARY TO
TO
TO
: : : : :
RECEIVE
RECEIVE
RECEIVE
RECEIVE
RECEIVE
100
% % % % %
& & & & &
LIFE
LIFE
LIFE
LIFE
LIFE
AD
AD
AD
AD
AD
D D D D D
SURVIVOR
SURVIVOR
SURVIVOR
SURVIVOR
SURVIVOR
ANNUITY
ANNUITY
ANNUITY
ANNUITY
ANNUITY
PRIMARY
PRIMARY
PRIMARY
PRIMARY
PRIMARY
CONTINGENT
CONTINGENT
CONTINGENT
CONTINGENT
CONTINGENT
Fred Smith is not married and has two children. He has enrolled in life insurance and Accidental Death and Dismemberment (AD&D). He wishes
his children to share equally if he dies:
. . . . .
. . . . .
BENEFICIARY
BENEFICIARY
BENEFICIARY
BENEFICIARY
BENEFICIARY LAST
LAST
LAST
LAST
LAST NAME
NAME
NAME
NAME
NAME
FIRST
FIRST
FIRST
FIRST
FIRST NAME
NAME
NAME
NAME
NAME
M M M M M
I I I I I
RELATIONSHIP
RELATIONSHIP
RELATIONSHIP
RELATIONSHIP
RELATIONSHIP
Smith
Jane
Daughter
R.
MAILING
MAILING
MAILING
MAILING
MAILING ADDRESS
ADDRESS
ADDRESS
ADDRESS
ADDRESS
CITY
CITY
CITY
CITY
CITY AND
AND
AND
AND
AND STATE
STATE
STATE
STATE
STATE
ZIP
ZIP
ZIP
ZIP
ZIP CODE
CODE
CODE
CODE
CODE
1000 "E" Street
Anytown, AK
99999
: : : : :
: : : : :
I I I I I WANT
WANT
WANT
WANT THIS
THIS
THIS
THIS BENEFICIARY
BENEFICIARY
BENEFICIARY
BENEFICIARY TO
TO
TO
TO RECEIVE
RECEIVE
RECEIVE THE
RECEIVE
THE
THE
THE FOLLOWING
FOLLOWING
FOLLOWING
FOLLOWING BENEFITS
BENEFITS
BENEFITS
BENEFITS IF IF IF IF IF I I I I I DIE
DIE
DIE
DIE
I I I I I WANT
WANT
WANT
WANT THIS
THIS
THIS
THIS BENEFICIARY
BENEFICIARY
BENEFICIARY
BENEFICIARY TO
TO
TO
TO BE
BE
BE
BE
WANT
THIS
BENEFICIARY
TO
RECEIVE
THE
FOLLOWING
BENEFITS
DIE
WANT
THIS
BENEFICIARY
TO
BE
I I I I I WANT
WANT
WANT
WANT
WANT THIS
THIS
THIS
THIS
THIS BENEFICIARY
BENEFICIARY
BENEFICIARY
BENEFICIARY
BENEFICIARY TO
TO
TO
TO
TO
: : : : :
RECEIVE
RECEIVE
RECEIVE
RECEIVE
RECEIVE
50
% % % % %
& & & & &
LIFE
LIFE
LIFE
AD
AD
AD
D D D D D
SURVIVOR
SURVIVOR
SURVIVOR
ANNUITY
ANNUITY
ANNUITY
PRIMARY
PRIMARY
PRIMARY
CONTINGENT
CONTINGENT
CONTINGENT
LIFE
LIFE
AD
AD
SURVIVOR
SURVIVOR
ANNUITY
ANNUITY
PRIMARY
PRIMARY
CONTINGENT
CONTINGENT
. . . . .
. . . . .
BENEFICIARY
BENEFICIARY
LAST
LAST
NAME
NAME
FIRST
FIRST
NAME
NAME
M M M M M
I I I I I
RELATIONSHIP
RELATIONSHIP
BENEFICIARY
BENEFICIARY
BENEFICIARY LAST
LAST
LAST NAME
NAME
NAME
FIRST
FIRST
FIRST NAME
NAME
NAME
RELATIONSHIP
RELATIONSHIP
RELATIONSHIP
Smith
John
Son
F.
MAILING
MAILING
MAILING
MAILING
MAILING ADDRESS
ADDRESS
ADDRESS
ADDRESS
ADDRESS
CITY
CITY
CITY
CITY
CITY AND
AND
AND
AND
AND STATE
STATE
STATE
STATE
STATE
ZIP
ZIP
ZIP
ZIP
ZIP CODE
CODE
CODE
CODE
CODE
1000 Any Street
Anytown, AK
99999
: : : : :
: : : : :
I I I I I WANT
WANT
WANT
THIS
THIS
BENEFICIARY
BENEFICIARY
TO
TO
RECEIVE
RECEIVE
THE
THE
FOLLOWING
FOLLOWING
BENEFITS
BENEFITS
BENEFITS IF IF IF IF IF I I I I I DIE
DIE
DIE
I I I I I WANT
WANT
WANT
THIS
THIS
BENEFICIARY
BENEFICIARY
TO
TO
BE
BE
WANT
WANT THIS
THIS
THIS BENEFICIARY
BENEFICIARY
BENEFICIARY TO
TO
TO RECEIVE
RECEIVE
RECEIVE THE
THE
THE FOLLOWING
FOLLOWING
FOLLOWING BENEFITS
BENEFITS
DIE
DIE
WANT
WANT THIS
THIS
THIS BENEFICIARY
BENEFICIARY
BENEFICIARY TO
TO
TO BE
BE
BE
I I I I I WANT
WANT
WANT
THIS
THIS
BENEFICIARY
BENEFICIARY
TO
TO
WANT
WANT THIS
THIS
THIS BENEFICIARY
BENEFICIARY
BENEFICIARY TO
TO
TO
: : : : :
RECEIVE
RECEIVE
RECEIVE
RECEIVE
RECEIVE
% % % % %
& & & & &
50
LIFE
LIFE
LIFE
LIFE
LIFE
AD
AD
AD
AD
AD
D D D D D
SURVIVOR
SURVIVOR
SURVIVOR
SURVIVOR
SURVIVOR
ANNUITY
ANNUITY
ANNUITY
ANNUITY
ANNUITY
PRIMARY
PRIMARY
PRIMARY
PRIMARY
PRIMARY
CONTINGENT
CONTINGENT
CONTINGENT
CONTINGENT
CONTINGENT
SECTION THREE: SIGNATURE
SECTION THREE: SIGNATURE
SECTION THREE: SIGNATURE
SECTION THREE: SIGNATURE
SECTION THREE: SIGNATURE
This form must be signed
This form must be signed
This form must be signed
This form must be signed
This form must be signed
G:/forms/benefits/02-1841.p65/1
(Rev. 10/00)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go