Transfer On Death (Tod) Beneficiary Form
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1
2J
M
F
T
OHNSON
UTUAL
UNDS
RUST
3777 W
F
R
EST
ORK
OAD
C
, O
45247
INCINNATI
HIO
For Internal Use
(513) 661-3100
A/C#
(800) 541-0170
(513) 661-3160
FAX
TRANSFER ON DEATH (TOD)
BENEFICIARY FORM
A
GREEMENT
Pursuant to the Uniform Transfer-on-Death Security Registration Act, and in accordance with section 1709.01 – 1709.11 of
the Act, I (we) hereby declare that this account #___________ with the Johnson Mutual Funds and the securities* contained
within, is registered as an
Individual Account or
Joint Account with Rights of Survivorship, and that I (we) are hereby naming
a transfer-on-death beneficiary.
The current account registration is as follows:
__________________________________________________
_____________________________
Account Owner
Social Security Number
______________________________________________________________
____________________________________
Account Owner
Social Security Number
__________________________________________________
_____________________________
Address of Record
Securities owned*
(JG, JO, JR, JF, JM, JDS, JDL, JDG, JEI, Other)
________________________________________________________
City/State/Zip Code
TOD B
D
ENEFICIARY
ESIGNATION
Subject to the limitations of section 5731.39 of the Revised Code, upon the death of the above named owner(s), ownership of the
securities in the above named account shall pass to the beneficiary(ies) who survive the owners upon proof of death of the owner or
both owners if this account is a Joint Account with Rights of Survivorship. If the beneficiary(ies) herein named fail to survive the
owner(s) and LDPS has been designated, the ownership shall pass to the named beneficiary(ies) lineal descendents per stirpes. (If you
would like to add more beneficiaries than the space provided, please attach a sheet containing the appropriate information).
Beneficiary Designation:
Beneficiary Designation:
_______________________________________________________
______________________________________________________________
Name
Name
_______________________________________________________
______________________________________________________________
Address
Address
________________________________________________________
______________________________________________________________
City/State/Zip Code
City/State/Zip Code
________________________________
________________
________________________________
__________________
Date of Birth
% Allocation
Date of Birth
% Allocation
________________________________
________________________________
Social Security Number
Social Security Number
*Securities may be added to the account after the initial registration and shall pass according to this agreement.
(over)
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