Pbgc Form 707 - Designation Of Beneficiary (Currently Receiving Pension Benefits) Page 3
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3Designation of Beneficiary
(Currently Receiving Pension Benefits)
Form 707, page 2 of 2
Case Number:
Participant Name / SSN:
3. Beneficiary –
I name the following person as my beneficiary for the purpose checked in #2. This designation replaces
any previous designation and will only be effective when PBGC receives it.
Last Name
First Name
Middle Name
Other Name(s) Used
Social Security Number
Date of Birth
Gender
MALE
-
-
/
/
FEMALE
Mailing Address
Apartment / Route Number
City
State
Zip Code
Country
Email (optional)
Daytime Phone
Evening Phone
E
XTENSION
(
)
-
x
(
)
-
Relationship to me, if any (e.g., spouse, granddaughter, friend)
4. Contingent beneficiary –
If the person I listed in section 3 dies before I do, I name the following person as my
contingent beneficiary.
Last Name
First Name
Middle Name
Other Name(s) Used
Social Security Number
Date of Birth
Gender
MALE
-
-
/
/
FEMALE
Mailing Address
Apartment / Route Number
City
State
Zip Code
Country
Email (optional)
Daytime Phone
Evening Phone
E
XTENSION
(
)
-
x
(
)
-
Relationship to me, if any (e.g., spouse, granddaughter, friend)
5. Signature
– You must sign and date this form.
SIGNATURE
DATE
SIGN & DATE BEFORE SUBMITTING. THANK YOU.
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