Fillable BENEFICIARY DESIGNATION FORM INSTRUCTIONS (City of Plano)

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BENEFICIARY DESIGNATION FORM INSTRUCTIONS (City of Plano)

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BENEFICIARY DESIGNATION FORM INSTRUCTIONS
FRM570-005-0213-6291-385
Please note: You only need to complete this form if your beneciary designation requires
spousal consent. See Section 4 to see if this applies to you.
In the event of your death, your designated beneciary(ies) will be entitled to any assets remaining in your ac-
count. Please provide all of the requested information for each beneciary – this information will help ICMA-
RC locate your beneciaries if necessary. You can always update your beneciary information online by
following the instructions below.
Designating beneciaries for your account is important:
• Your designation helps to ensure assets will be paid out according to your wishes and will not be subject
to the potential costs and delays of probate, as well as creditor claims. If all of your primary beneciaries
are no longer living at the time of your death, benets will be paid to your contingent beneciaries.
• Your beneciaries may receive more tax advantages.
Percent of Benet Information – If you provide percentages that do not total 100%, or provide non-whole
numbers, your designations will be invalid. However, if no percentages are provided for any beneciary desig-
nations, the benet will be allocated equally among all beneciaries.
Trust Beneciaries – If you name a trust as your primary or contingent beneciary, you must submit a com-
plete copy of your entire trust document with this form.
Update Beneciary Information Online
• Log in to ICMA-RC’s Account Access at www.icmarc.org
• Go to the Manage My Account tab and click the My Prole link
• Click the Beneciaries link
• Click the Update Beneciaries button and enter your beneciary information
Married Participants
If you do not designate your spouse as the primary beneciary for your account, your spouse may be required
to consent to your beneciary designation. Please review the additional information in the Spousal Consent
section (Section 4) of the form.
• VantageTrust Retirement IncomeAdvantage Fund Investors – To Lock-In and receive spousal ben-
ets from the Fund, your spouse must be designated as the primary beneciary for 100% of your ac-
count, both at the time you Lock-In the benet and at the time of your death. Additional information
is available in the VantageTrust Retirement IncomeAdvantage Fund Important Considerations document,
available online or by contacting ICMA-RC at 800-669-7400.
Fax or Mail the Completed Form to ICMA-RC
If you fax the form to ICMA-RC, please do not also send it to us by mail. Page 2 is only needed if your ben-
eciary designation requires spousal consent.
Fax: Mail:
ICMA-RC ICMA-RC
ATTN: Workow Management Team ATTN: Workow Management Team
202-682-6439 P.O. Box 96220
Washington, DC 20090-6220
Please keep a copy of completed form for your records.
BENEFICIARY DESIGNATION FORM - PAGE 1 OF 2
• Update your beneciary designations and/or designate additional beneciaries at any time via Account Access at www.icmarc.org.
• Your “Primary” beneciary(ies) must total 100% and your “Contingent” beneciary(ies) if applicable must also total 100%.
• Use whole percentages only (e.g., 50%, not 33.33% or 33
1
/3 %).
• Check one “Beneciary Type” and one “Relationship” for each beneciary. Failure to do so may result in your designation being invalid.
Beneciary Type: p Primary Relationship (Check One): p Spouse p Non-Spouse p Trust* p Charity p Estate
________________________________________________________ __ __ /__ __ /__ __ __ __ __ __ - __ __ - __ __ __ __ __ __ __%
Name Date of Birth Social Security Number % of Benet
Beneciary Type (Check One): p Primary p Contingent Relationship (Check One): p Spouse p Non-Spouse p Trust* p Charity p Estate
________________________________________________________ __ __ /__ __ /__ __ __ __ __ __ - __ __ - __ __ __ __ __ __ __%
Name Date of Birth Social Security Number % of Benet
Beneciary Type (Check One): p Primary p Contingent Relationship (Check One): p Spouse p Non-Spouse p Trust* p Charity p Estate
________________________________________________________ __ __ /__ __ /__ __ __ __ __ __ - __ __ - __ __ __ __ __ __ __%
Name Date of Birth Social Security Number % of Benet
Beneciary Type (Check One): p Primary p Contingent Relationship (Check One): p Spouse p Non-Spouse p Trust* p Charity p Estate
________________________________________________________ __ __ /__ __ /__ __ __ __ __ __ - __ __ - __ __ __ __ __ __ __%
Name Date of Birth Social Security Number % of Benet
Beneciary Type (Check One): p Primary p Contingent Relationship (Check One): p Spouse p Non-Spouse p Trust* p Charity p Estate
________________________________________________________ __ __ /__ __ /__ __ __ __ __ __ - __ __ - __ __ __ __ __ __ __%
Name Date of Birth Social Security Number % of Benet
*Trust Beneciaries – You must submit a copy of your entire trust document with this form.
Designate additional beneciaries online after your account is established, or write “see attached sheet” and attach and sign a separate piece of paper with your name, plan number, Social Security number, and the additional
beneciary information.
1) Use this form to designate beneciaries for your employer-sponsored retirement plan with ICMA-RC.
2) You only need to complete this form if your beneciary designation requires spousal consent. Otherwise, you may update your beneciary
information quickly and securely via Account Access at www.icmarc.org.
- Spousal Consent – If you are married and do not designate your spouse as primary beneciary for your account, your spouse may be required to
consent to your designation by signing Section 4 of this form. Please refer to Section 4 for additional information.
Social Security Number (for tax-reporting purposes)
___ ___ ___ - ___ ___ - ___ ___ ___ ___
Last First M.I.
Full Name of Participant
________________________________________________________________________________
ICMA-RC • Attn: Workow Management Team • P.O. Box 96220 • Washington, DC 20090-6220 • Toll Free 800-669-7400 • En Español 800-669-8216 • www.icmarc.org • Fax 202-682-6439
1. PERSONAL INFORMATION
2. BENEFICIARY DESIGNATION
Employer Plan Number Employer Plan Name
___ ___ ___ ___ ___ ___ ___________________________________________________________________
FRM570-005-0213-6291-385
REV/7/2014
Date of Birth
___ ___ / ___ ___ /___ ___ ___ ___
Month Day Year
Email Address
____________________________________
(whole % only)
(whole % only)
(whole % only)
(whole % only)
(whole % only)
________________________________________________________________ ____ ___/____ ____ /____ ____ ____ ____
Participant Signature Month Day Year
_________________________________________________________ ____ ___/____ ____ /____ ____ ____ ____
Employer Signature (if required) Month Day Year
3. SIGNATURES
ü
BENEFICIARY DESIGNATION FORM - PAGE 2 OF 2
Social Security Number
Employer Plan Number
__ __ __ __ __ __ __ __ __ - __ __ - __ __ __ __
Employer’s Plan Representative
__________________________________________________
Employer Signature
__________________________________________________
Name (Please Print)
__________________________________________________
Title
____ ___/____ ____ /____ ____ ____ ____
Month Day Year
Notary Public
Subscribed and sworn before me this ______ day of ______________________ (month), 20____
_________________________________________________
Notary Public’s Signature
Notary Public SEAL ___________________________
My commission expires _____________
ICMA-RC • Attn: Workow Management Team • P.O. Box 96220 • Washington, DC 20090-6220 • Toll Free 800-669-7400 • En Español 800-669-8216 • www.icmarc.org • Fax 202-682-6439
Community Property States (AZ, CA, ID, LA, NV, NM, TX, WA, or WI) – A participant living in a community property state must designate his/
her spouse as the primary beneciary for at least 50% of the account, unless the spouse waives his/her right by consenting to an alternative beneciary
designation. By signing below, you (the participant’s spouse) are consenting to the benet percentage specied below and the participant’s beneciary
designation(s) on page 1 of this form.
401 Dened Contribution Plans – Many 401 plans require that a married participant designate his/her spouse as the primary beneciary for 100% of
the account, unless the spouse waives his/her right by consenting to an alternative beneciary designation. By signing below, you are consenting to the
benet percentage specied below and the participant’s beneciary designation(s) on page 1 of this form.
State Law: ICMA-RC makes this form available as a means of helping participants satisfy state law requirements relating to beneciary designations.
ICMA-RC is not responsible for a participant’s failure to properly designate a beneciary in accordance with state law. Failure to satisfy state law
requirements may result in a beneciary designation being invalidated, and benets being paid in accordance with state law.
Spousal Consent and Acknowledgement: By signing below, I agree to waive my beneciary rights in my spouse’s retirement plan account, and consent to
1) receive the benet percentage specied below, and 2) the beneciary designation on page 1 of this form. I understand this waiver will result in some or
all of my spouse’s death benet being paid to someone other than me. I further understand that future changes to my spouse’s beneciary designations will
not be valid unless I consent to any such changes.
Spouse Benet Percentage (whole % only): ___ ___ ___ % (This percentage should match the percentage, if any, specied on page 1 of the form. Write “0” if applicable.)
_________________________________________________________ ____ ___/____ ____ /____ ____ ____ ____
Spouse Signature Month Day Year
_________________________________________________________
Name (Please Print)
4. SPOUSAL CONSENT
5. WITNESS
• For 457 deferred compensation plans, a Notary Public is required to witness the spouse signature for the above spousal consent to be valid in a com-
munity property state.
• For 401 dened contribution plans, the above spousal consent must be witnessed by either an authorized employer plan representative or a Notary
Public.
Last First M.I.
Full Name of Participant (Please Print)
__________________________________________________________________________
FRM570-005-0213-6291-385
REV/7/2014
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BENEFICIARY DESIGNATION FORM INSTRUCTIONS (City of Plano)

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Completed 4 August 2020

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