Transfer On Death (Tod) And Beneficiary Designation Page 2
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Primary Beneficiary Information. The following individuals shall be my (our) Primary Beneficiary(ies):
Use additional forms if necessary. Please note: Primary Beneficiary percentage shares must equal 100%. Do not use fractional
percentages or dollar amounts.
Primary Beneficiary #1
______________________________________________
______________________ _____________________
Name
Percentage Share
Relationship
______________________________________________
_____________________________________________
Street Address
Social Security Number
______________________________________________
(_____) ______ - _________
City, State, Zip
Telephone
Primary Beneficiary #2
______________________________________________
______________________ _____________________
Name
Percentage Share
Relationship
______________________________________________
_____________________________________________
Street Address
Social Security Number
______________________________________________
(_____) ______ - _________
City, State, Zip
Telephone
Primary Beneficiary #3
______________________________________________
______________________ _____________________
Name
Percentage Share
Relationship
______________________________________________
_____________________________________________
Street Address
Social Security Number
______________________________________________
(_____) ______ - _________
City, State, Zip
Telephone
Primary Beneficiary #4
______________________________________________
______________________ _____________________
Name
Percentage Share
Relationship
______________________________________________
_____________________________________________
Street Address
Social Security Number
______________________________________________
(_____) ______ - _________
City, State, Zip
Telephone
Transfer on Death (TOD) - Beneficiary Designation
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