Pbgc Form 708 - Designation Of Beneficiary (Not Currently Receiving Pension Benefits) Page 2
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3Designation of Beneficiary
PBGC Form 708
Approved OMB 1212-0055
(Not Currently Receiving Pension Benefits)
Expires 12/31/15
Pension Benefit Guaranty Corporation.
For assistance, call 1-800-400-7242
P.O. Box 151750, Alexandria, Virginia 22315-1750
Plan Name: FX.PrismCase.CaseTitle.XF
Plan Number: FX.PrismCase.CaseIdNmbr.XF
Participant Name: FX.PrismCust.FullName.XF
Date Printed: 03/25/2013
Date of Plan Termination: FX.PrismCase.DOPT.XF
INSTRUCTIONS:
Use this form to designate your beneficiary.
To begin receiving benefits, or for other
information, call our Customer Contact Center at 1-800-400-7242. Please print clearly with blue or black ink.
1. General information about you
Last Name
First Name
Middle Name
Other Name(s) Used
Social Security Number
-
-
Mailing Address
Apartment / Route Number
City
State
Zip Code
Country
Email
Daytime Phone
Evening Phone
Extension
(
)
-
x
(
)
-
2. Signature
– Sign and date this document. Knowingly and willfully making false, fictitious or fraudulent
statements to the Pension Benefit Guaranty Corporation is a crime punishable under Title 18, Section 1001,
United States Code.
I declare under penalty of perjury that all of the information I have provided on this form is true and correct.
SIGNATURE
DATE
CONTINUE
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