Pbgc Form 707 - Designation Of Beneficiary (Currently Receiving Pension Benefits) Page 2
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3Designation of Beneficiary
PBGC Form 707
Approved OMB 1212-0055
(Currently Receiving Pension Benefits)
Expires 09/30/08
Pension Benefit Guaranty Corporation.
For assistance, call 1-800-400-7242
P.O. Box 151750 Alexandria Virginia 22315-1750
Case Name:
Case Number:
Participant Name / SSN:
Date of Plan Termination
INSTRUCTIONS
: Use this form to name or change your beneficiary. Be sure to print clearly and use dark ink. If you have
any questions, please call our Customer Contact Center at 1-800-400-7242.
1. General information about you
Last Name
First Name
Middle Name
Other Name(s) Used
Social Security Number
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Mailing Address
Apartment / Route Number
City
State
Zip Code
Country
Email (optional)
Daytime Phone
Evening Phone
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XTENSION
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2. Beneficiary Designation
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Please indicate the type of designation you are making. If you want to designate different
persons to receive the two types of payments, please use a separate form for each. If you want to designate the same person,
check both boxes. If the beneficiary you name dies before you, PBGC will pay the amount we owe you in this order: your
spouse, your children, your parents, your estate, and your next of kin.
Designation of Beneficiary for Annuity Benefits Payable after Death –
Annuity benefits, other than joint-and-
survivor benefits, that are payable to your beneficiary for periods after your death.
Designation of Beneficiary for Benefits Due at Death –
This designation covers payments that PBGC may owe
you at the time of your death such as back payments for benefit estimates that were too low. If your benefit continues
after your death (as with a joint-and-survivor or certain-and-continuous annuity), the person named to receive those
continuing benefits will receive any payments due to you at the time of your death. If not, PBGC will make any
payments due to you at the time of your death to the person you name below. If you do not name anyone, or if the
beneficiary you name dies before you, PBGC will pay the amount we owe you in this order: your spouse, your children,
your parents, your estate and your next of kin.
CONTINUE
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