Fillable Beneficiary Form (California Lutheran University)

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Beneficiary Form (California Lutheran University)

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Beneficiary Designation form
TA_MB
F11468 (6/14)
QUESTIONS?
For account information or
any questions:
Call 800 842-2252
Monday – Friday
8 a.m. – 10 p.m. (ET)
Saturday
9 a.m. – 6 p.m. (ET)
Or visit us online at
tiaa-cref.org 24 hours a
day. Have your user ID and
password ready.
IMPORTANT INFORMATION
Use this form to update existing or to designate new beneficiary(ies) on your TIAA-CREF pension annuities
and/or IRA accounts. For changes to other product or account types, please visit us at tiaa-cref.org or call us
at 800 842-2252.
Did you know that incomplete information can make it difficult for us to find your beneficiaries?
To help ensure that your beneficiaries receive their survivor benefits, it’s important that we have complete
information on file to locate them at all times. This includes each beneficiary’s name, address, telephone
number, date of birth, Social Security Number or Taxpayer Identification Number and relationship to you and
the portion of the benefits to which they are entitled. If you haven’t already done so, please update your
beneficiary designation with all of this information as soon as possible. And, we also recommend that you
review and update your beneficiary information periodically to make sure it continues to be accurate.
To update or change your beneficiary designation, please visit us online at www.tiaa-cref.org/profile or
complete this Designation of Beneficiary form and mail back to us. To obtain a form, visit our website at
www.tiaa-cref.org/beneficiary, or call us at 800 842-2252.
Selecting a Beneficiary
A beneficiary can be an individual, an institution, an organization, a testamentary trust, or your estate.
(Naming an estate may limit options available to your heirs. Please consult with an attorney prior to naming
your estate or trust.) Beneficiaries can also be the children of the beneficiaries that you designate on this
form. You can choose primary and contingent beneficiaries. Your primary beneficiary(ies) receives benefits
at the time of your death. If a class includes more than one person, the benefits are paid proportionately
among the living beneficiaries of the class unless you specify otherwise. If there are no living primary
beneficiaries at the time of your death, the benefits become payable to your contingent beneficiaries. If
none of the beneficiaries are living at the time of your death, the benefits will default to the plan or product
provisions. The order of payment and division of benefits is provided for in the Additional Provisions section.
Spousal Rights to Annuity Death Benefits
If you live in a community or marital property state and have designated someone other than your spouse as
more than 50% primary beneficiary, you need to consult your tax advisor regarding the effect that may have
on your beneficiary designation. Community and marital property states include, but are not limited to: AZ,
CA, ID, LA, NV, NM, TX, WA and WI.
Federal pension law (ERISA) and certain Plan and State provisions mandate:
If you are married at the time of your death, your spouse is entitled to receive, as primary beneficiary, at
least 50%, could be up to 100%, of your qualified preretirement survivor annuity death benefits under
a retirement or tax-deferred annuity plan covered by any of the following: ERISA or your plan’s spousal
policy. If you name someone other than your spouse as primary beneficiary of those qualified preretirement
survivor annuity death benefits, then we will be obligated to pay your spouse regardless of your beneficiary
designation in effect at the time of your death. The remainder will be payable in proportion of the amounts
allocated to the other beneficiary(ies) listed as primary.
Beneficiary Designation form
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F11468 (6/14)
Please contact your human
resources administrator for
any special employer rules.
IMPORTANT INFORMATION (CONTINUED)
How to waive a preretirement survivor death benefit?
Please consult with your Plan Representative for more information.
If you are married and want more than 50% of your benefits (or the plan determined amount, if greater)
to go to someone other than your spouse, your spouse must authorize the designation by completing the
Spousal Waiver form. A Notary Public or Plan Representative must witness your spouse signing and dating
the spousal waiver. Under federal law, if you are under 35, your spouse cannot complete a Spousal Waiver
unless your plan provides otherwise. Even if your plan does allow your spouse to complete a Spousal Waiver,
your spouse must complete another Spousal Waiver once you attain age 35.
If the spousal waiver section is not completed and signed at the time you make your designation, we will
continue to update your designation but at the time of your death, we will advise your spouse of his/her legal
right to their portion of your contract at which time he/she can waive their rights or claim their inheritance.
Beneficiary Designation form
Page 1 of 7
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F11468 (6/14)
Print in upper case using
black or dark blue ink and
provide all information
requested.
To help avoid incorrect
interpretation or delays,
please be sure that all
handwritten information is
legible.
1. PROVIDE yOuR INFORMATION
First Name Middle Initial
Last Name Suffix
Social Security Number/
Taxpayer Identification Number Date of Birth (mm/dd/yyyy)
/
/
Address
City State Zip Code
Contact Telephone Number Extension
Email Address
Check the first box if you
want the same beneficiary
designation(s) for all your
applicable TIAA-CREF
annuity contracts. Check the
second box only if you want
the beneficiary designation
applied to specific contracts.
2. APPlIcAblE cONTRAcTs
This beneficiary designation applies to:
ALL my active TIAA-CREF pension, annuity and IRA contracts
OR
ONLY my TIAA-CREF pension, annuity or IRA contract set(s) indicated below:
TIAA Number CREF Number
TIAA Number CREF Number
TIAA Number CREF Number
Designations can only be at the contract level. Plan-based designations are not acceptable.
NOTE: If you wish to make changes to other products you hold at TIAA-CREF, please visit us at tiaa-cref.org or
call us at 800 842-2252.
Beneficiary Designation form
Page 2 of 7
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F11468 (6/14)
NOTE: The person you are
legally married to today
may or may not be the
person you are legally
married to at the time
of your death, so please
do not complete the
information on your current
spouse today. We can find
all pertinent information on
your current spouse at the
time of your death.
*
T
IAA cannot accept a
‘Will’ as a designation.
Testamentary trusts are
acceptable if we are
provided with the “Will”
creation date of which
the Testamentary trust
will be issued.
If your percentage does
not equal 100% or is not
provided, we will prorate
the unspecified percentage
equally.
See Provisions at end of
this form.
3. chOOsINg yOuR PRIMARy bENEFIcIARy
Tell us who should receive your account balance after your death.
% to the person I am legally married to at the time of my death.
NOTE: If you chose the person you are legally married to at the time of your death for the full 100%, skip to the Contingent Beneficiary
section. If you chose a lessor amount for your spouse then update only the person(s) receiving the difference. Your confirmation
statement will list the person who you are legally married to with the percentage you have elected. When entering a lessor amount,
please keep in mind ERISA requirements or Plan requirements regarding spousal rights.
1. First Name Middle Initial
Last Name Percentage
%
Relationship
Address
City State Zip Code
Contact Telephone Number Country Gender
F M
Social Security Number/ Date of Birth/Date of Trust/
Taxpayer Identification Number Issue Date of Will (mm/dd/yyyy)
/ /
2. First Name Middle Initial
Last Name Percentage
%
Relationship
Address
City State Zip Code
Contact Telephone Number Country Gender
F M
Social Security Number/ Date of Birth/Date of Trust/
Taxpayer Identification Number
Issue Date of Will (mm/dd/yyyy)
/ /
Beneficiary Designation form
Page 3 of 7
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F11468 (6/14)
If you have more than
one primary beneficiary,
benefits will be divided
equally among the living
beneficiaries unless you
specify the percentage. The
percentages for all of the
primary beneficiaries must
total 100%.
TIAA cannot accept a
‘Will’ as a designation.
Testamentary trusts are
acceptable if we are
provided with the “Will”
creation date of which the
Testamentary trust will be
issued.
3. chOOsINg yOuR PRIMARy bENEFIcIARy (CONTINUED)
3. First Name Middle Initial
Last Name Percentage
%
Relationship
Address
City State Zip Code
Contact Telephone Number Country Gender
F M
Social Security Number/ Date of Birth/Date of Trust/
Taxpayer Identification Number Issue Date of Will
(mm/dd/yyyy)
/ /
4. First Name Middle Initial
Last Name Percentage
%
Relationship
Address
City State Zip Code
Contact Telephone Number Country Gender
F M
Social Security Number/ Date of Birth/Date of Trust/
Taxpayer Identification Number Issue Date of Will (mm/dd/yyyy)
/ /
Check this box and attach a signed letter, to list additional primary and/or contingent beneficiaries, a
trust, or to provide additional instructions. Please include your contract numbers.
Beneficiary Designation form
Page 4 of 7
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F11468 (6/14)
If you have more than one
contingent beneficiary,
benefits will be divided
equally among the living
beneficiaries unless you
specify the percentage. The
percentages for all of the
contingent beneficiaries
must total 100%.
TIAA cannot accept a
‘Will’ as a designation.
Testamentary trusts are
acceptable if we are
provided with the “Will”
creation date of which the
Testamentary trust will be
issued.
** If you check ‘payment to
my deceased beneficiary’s
children’ and the named
beneficiary predeceases
you, the monies which
would have been paid to
that beneficiary will be
divided proportionately
among his/her children
(if any). If there are
no living children for
that beneficiary their
portion will be paid
proportionately to the
remaining beneficiaries
in that class. In the
event there are no other
beneficiaries, we will pay
your Estate.
4. chOOsINg yOuR cONTINgENT bENEFIcIARIEs
Tell us who should receive your account balance after your death.
1. First Name Middle Initial
Last Name Percentage
%
Relationship
Payments made to this deceased
beneciary’s children**
Address
City State Zip Code
Contact Telephone Number Country Gender
F M
Social Security Number/ Date of Birth/Date of Trust/
Taxpayer Identification Number Issue Date of Will
(mm/dd/yyyy)
/ /
2. First Name Middle Initial
Last Name Percentage
%
Relationship
Payments made to this deceased
beneciary’s children**
Address
City State Zip Code
Contact Telephone Number Country Gender
F M
Social Security Number/ Date of Birth/Date of Trust/
Taxpayer Identification Number Issue Date of Will
(mm/dd/yyyy)
/ /
Beneficiary Designation form
Page 5 of 7
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F11468 (6/14)
If you have more than one
contingent beneficiary,
benefits will be divided
equally among the living
beneficiaries unless you
specify the percentage. The
percentages for all of the
contingent beneficiaries
must total 100%.
TIAA cannot accept a
‘Will’ as a designation.
Testamentary trusts are
acceptable if we are
provided with the “Will”
creation date of which the
Testamentary trust will be
issued.
** If you check ‘payment to
my deceased beneficiary’s
children’ and the named
beneficiary predeceases
you, the monies which
would have been paid to
that beneficiary will be
divided proportionately
among his/her children
(if any). If there are
no living children for
that beneficiary their
portion will be paid
proportionately to the
remaining beneficiaries
in that class. In the
event there are no other
beneficiaries, we will pay
your Estate.
4. chOOsINg yOuR cONTINgENT bENEFIcIARIEs (CONTINUED)
3. First Name Middle Initial
Last Name Percentage
%
Relationship
Payments made to this deceased
beneciary’s children**
Address
City State Zip Code
Contact Telephone Number Country Gender
F M
Social Security Number/ Date of Birth/Date of Trust/
Taxpayer Identification Number Issue Date of Will
(mm/dd/yyyy)
/ /
4. First Name Middle Initial
Last Name Percentage
%
Relationship
Payments made to this deceased
beneciary’s children**
Address
City State Zip Code
Contact Telephone Number Country Gender
F M
Social Security Number/ Date of Birth/Date of Trust/
Taxpayer Identification Number Issue Date of Will
(mm/dd/yyyy)
/ /
Beneficiary Designation form
Page 6 of 7
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F11468 (6/14)
Please provide your
signature and the date.
5. yOuR sIgNATuRE
I, the undersigned, agree that:
All prior beneficiary designations previously requested and any benefits due by reason of my death will be
payable to the beneficiary(ies) named on this form, if I elected option 1 in Section 2.
I understand that this form is subject to all of the terms and conditions of the pension, annuity and IRA
contracts as described in Section 3.
I reserve the right to make further changes to my beneficiary designations.
If you named an irrevocable beneficiary, your annuity partner will be unable to change the designation at
any time.
I understand that if I elect to have this designation apply to all of my referenced accounts, it will apply
ONLY to those active as of the date this form is accepted by TIAA-CREF.
I understand that if any or all of my accumulation for which this designation applies is subject to Spousal
Consent under plan or ERISA rules, my spouse must complete a spousal waiver form.
I understand that if I elect ‘payment to my deceased beneficiary’s children’ that I agree with TIAA’s
interpretation of how the benefits at my death will be paid as outlined in this form.
I understand and agree to the changes and updates I made on this form.
Your Signature Today’s Date
(mm/dd/yyyy)
/ /
2 0
Beneficiary Designation form
Page 7 of 7
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F11468 (6/14)
The Employee Retirement
Income Security Act of 1974
(ERISA) provides certain
rights to the spouse of a
participant in a retirement
plan subject to the law.
Some Non-ERISA plans
may also require that we
pay from 50% to 100% to a
surviving spouse at death.
NOTE: Due to Plan Provisions
or Employee Retirement
Income Security Act (ERISA)
regulations we need to
verify if there is a surviving
spouse. This verification
will be completed prior to
benefits being paid/ settled
to any beneficiary.
6. ADDITIONAl REquIREMENTs bAsED ON MARITAl sTATus
6A. IF YOU ARE SINGLE, COMPLETE THIS SECTION
Check the box if you are not married
I am not married.
6B. YOU ARE MARRIED
If you are married and have not designated your spouse as a primary beneficiary for at least 50% of the
benefit, or the percentage required by ERISA or your plan, your spouse must complete this section in front of
a Notary Public or your current employer’s plan representative.
In order to ensure that your spouse has seen your intentions and can attest that they fully agree to waive their
rights, your spouse’s signature must be the same or a later date than you signed in Section 6.
TO BE COMPLETED BY YOUR SPOUSE
Consent by Spouse (Must Be Completed by Your Spouse and Witnessed)
With this consent, I voluntarily and irrevocably give up my right to a death benefit that I may be entitled to
under spousal consent/law. I recognize that any death benefit payable under these annuities or the mutual
funds will be paid to the beneficiaries as described on this form.
First Name Last Name
Signature Today’s Date (mm/dd/yyyy)
/ /
2 0
FOR NOTARY PUBLICS IN
MASSACHUSETTS ONLY
Indicate the type of
identification:
NOTARY PUBLIC CERTIFICATION
State County Notary Expiration Date (mm/dd/yyyy)
/ /
2 0
On the date noted below the subscriber known to me to be the person described in and who executed the
foregoing instrument and he/she acknowledged to me that he/she executed the same.
Notary Public’s Signature Today’s Date
(mm/dd/yyyy)
/ /
2 0
Valid federal or state ID
Testimony of a credible witness
Personal knowledge of the subscriber
OR
In this space, the Notary Public must provide his/her
notarial number and the date the appointment expires.
Provide the notarial seal if outside New York state
PLAN REPRESENTATIVE CERTIFICATION
By signing, you are certifying you witnessed the spouse’s signature.
Plan Representative’s Signature Today’s Date (mm/dd/yyyy)
/ /
2 0
Plan Representative’s Name (Please print) Title
Beneficiary Designation form
TA_MB
F11468 (6/14)
chEcklIsT
Did you remember to:
Provide all the personal information requested and choose your beneficiaries.
Initial any changes made within the form and be sure to sign and date the agreement in Section 5.
Complete the “Additional Requirements Based on Marital Status” section. If you are single, complete
Section 6A; if you are married and have not designated your spouse as a primary beneficiary of at least
50% of the benefit, or the percentage required by your plan, your spouse must complete Section 6B in
front of a Notary Public or your current employer’s plan representative.
If applicable, attach a signed and dated page to list special provisions for deceased beneficiaries.
Original documents are
required. Faxes cannot be
accepted.
RETuRN cOMPlETED FORM TO:
STANDARD MAIL: OVERNIGHT:
TIAA-CREF TIAA-CREF
P.O. Box 1268 8500 Andrew Carnegie Blvd.
Charlotte, NC 28201-1268 Charlotte, NC 28262
BENEFICIARY PROVISIONS
1. Effectiveness
This Designation of Beneficiary is effective for each annuity contract and certificate listed by number or
by definition of contracts as stated in the Annuity Numbers section. If the beneficiary designations are
satisfactory by TIAA-CREF’s standards and the designations are accepted by TIAA-CREF, the designations
will be effective from the date the form was received in good order by TIAA-CREF.
2. Immediate Annuity under a Two-Life Option
If you own an Immediate Annuity under a Two-Life Option, you have already provided for benefits at your
death for the second annuitant. Therefore, your second annuitant should not be named as a beneficiary.
If you do designate your second annuitant, TIAA-CREF will remove that person from the contract’s
designation. Your confirmation will display this change.
3. Order of Payment and Division of Benefits
a. Unless otherwise stated: At your death (or the last surviving annuitant’s death under a Two-Life
Annuity), any benefits due will be paid to a beneficiary if he or she is then living. If a class of
beneficiaries contains more than one person, benefits due to the beneficiaries in such class at your
death (or the last surviving annuitant’s death under a Two-Life Annuity) will be paid in accordance
with the proportions stated. If a beneficiary predeceases you (or the last surviving annuitant under a
Two-Life Annuity), the proportion of the benefits that would have otherwise been apportioned to such
deceased beneficiary shall instead be divided to the other beneficiaries who survive you (or the last
surviving annuitant under a Two-Life Annuity).
b. If all beneficiaries predecease you (or the last surviving annuitant under a Two-Life Annuity), all benefits
will be payable to your estate (or the estate of the last surviving annuitant under a Two-Life Annuity).
Beneficiary Designation form
TA_MB
F11468 (6/14)
ADDITIONAl PROVIsIONs
Provision: ‘Payment to my deceased beneficiary’s children’ provision applied to a beneficiary means that
if you check ‘payment to my deceased beneficiary’s children’ and the named beneficiary predeceases you,
the monies which would have been paid to that beneficiary will be divided proportionately among his/her
children (if any). If there are no living children for that beneficiary, their portion will be paid in proportion to
the remaining beneficiaries in that class. In the event there are no other beneficiaries, we will pay your Estate.
Example:
John Doe – your son with a 100% designation ‘payment to my deceased beneficiary’s children’
Jane Doe – your daughter with a 100% designation ‘payment to my deceased beneficiary’s children’
John predeceases you. Then John’s portion will be paid to his children equally. If John has no children, his
share will then be paid to Jane. If both John and Jane predecease you and there are no children, we will pay
the contingent beneficiaries you designate. In absence of any contingent beneficiaries, we will pay your Estate.
4. If a Testamentary Trust is Designated as Beneficiary:
a. TIAA-CREF will not accept or be obliged to inquire into the terms of any will or of any trust affecting
the annuity contract/certificate or its death benefit and shall not be charged with knowledge of terms
thereof.
b. TIAA can only accept a testamentary trust if you give us the create date of the will at the time of the
designation. A designation of Will is not acceptable.
c. If benefits become payable to a testamentary trust and (i) the will is not presented for probate within 90
days following the date of your death (or the death of the last surviving annuitant in a Two-Life Annuity);
or (ii) the will has been presented for probate within the aforesaid 90 days and no qualified trustee
makes claim for the benefits within nine months after your death (or the death of the last surviving
annuitant in a Two-Life Annuity); or (iii) if evidence is furnished and is satisfactory to TIAA-CREF within
such nine-month period that no trustee can qualify to receive the benefits, payment shall be made to
the successor beneficiary(ies), if any such beneficiary(ies) (is)are designated and survive you (or the
last surviving annuitant in a Two-Life Annuity): otherwise to your estate (or the estate of the last surviving
annuitant).
d. If benefits become payable to an inter vivos trust and (i) the trust agreement is not in effect; or (ii)
no trustee can qualify to receive the benefits; or (iii) the qualified trustee is not willing to accept
the benefits, payments shall be made to the successor beneficiary(ies) as designated, if any such
beneficiary(ies) are designated and survive(s) you (or the last surviving annuitant in a Two-Life Annuity);
otherwise to your estate (or to the estate of the last surviving annuitant).
e. Payment to, and receipt by, said trustee, said successor beneficiary(ies) or said estate, as provided
for in (b) and (c) above, shall fully discharge TIAA-CREF for all liability to the extent of such payment.
TIAA-CREF shall have no obligations as to the application of funds so paid and shall, in all dealings with
said trustee or with said executor(s) or administer(s), including but not limited to any consent, release or
waiver of interest, be fully protected against the claims or demands of any other person(s).
Beneficiary Designation form
TA_MB
F11468 (6/14)
FRAuD WARNINg
FOR YOUR PROTECTION, WE PROVIDE THIS NOTICE/WARNING REQUIRED BY MANY STATES
This notice/warning does not apply in New York.
Any person who, knowingly and with intent to defraud any insurance company or other person, files
an application for insurance or a statement of claim for insurance benefits containing materially false
information or conceals, for the purpose of misleading, information concerning any fact material thereto,
commits a fraudulent insurance act, which is a crime and may be subject to criminal penalties, including
confinement in prison, and civil penalties. Such action may entitle the insurance company to deny or void
coverage or benefits.
Colorado residents, please note: Any insurance company or agent of an insurance company who knowingly
provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of
defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable
from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of
Regulatory Agencies.
Virginia and Washington, DC residents, please note: Any person who knowingly presents a false or
fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application
for insurance is guilty of a crime and may be subject to fines and confinement in prison.
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Beneficiary Form (California Lutheran University)

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Completed 20 July 2020

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