Form Ira/403(B)(7) - Custodial Account - Change Of Beneficiary Page 3
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42. Beneficiary Designations (continued)
Type:
Primary
Contingent
Share Percentage ______________%
Relationship to Shareowner:
Spouse
Nonspouse
Name _________________________________________________________________________________________________________
Residence Address ________________________________________________________________________________________________
Suite/Apt. No.
City _____________________________________________________________________State ______________ ZIP Code ___________
Taxpayer ID Number _____________________________________________ Date of Birth (mm/dd/yyyy) _______ / _______ / __________
Spousal Consent (if applicable)
Complete this section only if you, the shareowner, have your legal residence in a community or marital property state and you wish to name a
beneficiary other than or in addition to your spouse as primary beneficiary. This section may have important tax consequences to you and your
spouse, so please consult with a competent advisor prior to completing. If you are not currently married and you marry in the future, you must
complete a new beneficiary designation that includes the spousal consent provisions. If this is an Inherited IRA, seek competent legal/tax advice
to see if spousal consent is required.
Consent of Spouse
By signing below, I acknowledge that I am the spouse of the shareowner and agree with and consent to my spouse’s designation of a primary
beneficiary other than, or in addition to, me. I have been advised to consult a competent advisor and I assume all responsibility regarding this
consent. The custodian has not provided me any legal or tax advice.
Signature of Spouse X ________________________________________________________Date _________________________________
Witness X _________________________________________________________________Date _________________________________
3. Signature(s)
Please accept this authorization to designate a beneficiary(ies) or to change a designation of beneficiary(ies). The instructions I have provided
replace any previously submitted beneficiary designation including the designation contained in the Account Application establishing the Account
Number(s) referenced in Section 1. I hereby consent to the designation of beneficiary as stated in Section 2.
Your Signature X ____________________________________________________________Date _________________________________
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Change of BenefiCiary form
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