Fillable IRA Add/Change of Beneficiary

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IRA Add/Change of Beneficiary

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The IRA Add/Change of Beneficiary form is 7 pages long and contains:

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  • 12 check-boxes
  • 190 other fields

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Investment and Insurance Products are:
• Not Insured by the FDIC or Any Federal Government Agency
• Not a Deposit or Other Obligation of, or Guaranteed by, the Bank or Any Bank Affiliate
• Subject to Investment Risks, Including Possible Loss of the Principal Amount Invested
Wells Fargo Advisors is a trade name used by Wells Fargo Clearing Services, LLC (WFCS), Member SIPC, a registered broker-dealer and non-bank
affiliate of Wells Fargo & Company. WellsTrade brokerage accounts are offered through WFCS.
Office Use Only:
Sub Firm # BR Code FA Code Account Number
578639 (Rev 21 - 09/21) Page 1 of 7
IRA Add/Change of Beneficiary
This IRA Change of Beneficiary form will supersede and replace all prior beneficiary designations once
received and accepted. For more information about the IRA Custodian and the terms and conditions of the account,
please carefully review the WFCS IRA Disclosure Statement and Custodial Agreement.
Section 1: IRA Holder and Account Information
IRA Holder Name Account Number (Required for WellsTrade® and Intuitive Investor® Accounts.)
IRA Type
(select one)
Traditional Roth SEP/SAR-SEP SIMPLE Inherited Traditional Inherited Roth
Section 2: Beneficiary Information
If you prefer to name your beneficiary designations (names, contact information, percentages, etc.) on a separate signed
and dated document instead of using this form, please do not complete Section 2. Instead, proceed to Section 3 to
name a Personal Representative and follow submission instructions.
Important Information When Naming Minor Beneficiaries
If any of your designated beneficiaries are minors, you must designate a responsible individual called a Custodian under
the Uniform Transfer to Minors Act (UTMA)/Uniform Gifts to Minors Act (UGMA) as adopted by the relevant state. The
UTMA/UGMA Custodian does not have to be the minor’s parent or legal guardian. If you do not name a UTMA/UGMA
Custodian or the named Custodian is unable or unwilling to serve for any reason, the IRA Custodian may require a
UTMA/UGMA Custodian under the UTMA/UGMA to be appointed by an authorized court. Unless the IRA Custodian is
informed by you otherwise, the account will be set up using the UTMA/UGMA Custodian’s state of residence’s default
age. The UTMA/UGMA Custodian will agree that he or she is responsible for determining the proper termination age.
You should consult with an attorney or tax advisor before naming a minor as a beneficiary.
Primary Beneficiary
Please provide the full legal name and beneficiary type for each listed beneficiary. Social Security number/Tax ID and
date of birth are recommended but not required and can be provided at any time. The Trust Date, other than a
testamentary trust, is required if a trust is designated as beneficiary.
Check “Per Stirpes” if you want the selected beneficiary’s share of the IRA to go to their lineal descendants (generally
children). This will only occur if you outlive the selected beneficiary or the beneficiary disclaims. If you select Per Stirpes,
please complete Section 3 to designate your Personal Representative.
If a beneficiary is a minor provide the full name of a responsible individual/designated UTMA/UGMA Custodian (does
not have to be the minor’s parent or legal guardian). If no designated UTMA/UGMA Custodian is named, the IRA
Custodian may require a designated UTMA/UGMA Custodian under UGMA/UTMA to be appointed by an authorized
court.
Total percentage of benefits for the listed primary beneficiaries must equal 100%.
Clear Form
Office Use Only:
Sub Firm # BR Code FA Code Account Number
578639 (Rev 21 - 09/21) Page 2 of 7
Type (select one)
Spouse
Non-Spouse
Non-Spouse
-Minor
Trust
Other Entity
Primary Beneficiary Name – 1 (If naming a spouse, do so here.) Phone Number
Address & Email
Social Security Number/Tax ID
Date of Birth/Trust
% of Benefits
Per Stirpes
Complete Section 3 to designate
your Personal Representative.
If beneficiary is a minor provide the full name of responsible individual/UTMA/UGMA Custodian
Type (select one)
Non-Spouse
Non-Spouse
-Minor
Trust
Other Entity
Primary Beneficiary Name – 2 Phone Number
Address & Email
Social Security Number/Tax ID Date of Birth/Trust % of Benefits
Per Stirpes
Complete Section 3 to designate
your Personal Representative.
If beneficiary is a minor provide the full name of responsible individual/UTMA/UGMA Custodian
Type (select one)
Non-Spouse
Non-Spouse
-Minor
Trust
Other Entity
Primary Beneficiary Name – 3 Phone Number
Address & Email
Social Security Number/Tax ID Date of Birth/Trust % of Benefits
Per Stirpes
Complete Section 3 to designate
your Personal Representative.
If beneficiary is a minor provide the full name of responsible individual/UTMA/UGMA Custodian
Type (select one)
Non-Spouse
Non-Spouse
-Minor
Trust
Other Entity
Primary Beneficiary Name – 4 Phone Number
Address & Email
Social Security Number/Tax ID Date of Birth/Trust
% of Benefits
Per Stirpes
Complete Section 3 to designate
your Personal Representative.
If beneficiary is a minor provide the full name of responsible individual/UTMA/UGMA Custodian
Type (select one)
Non-Spouse
Non-Spouse
-Minor
Trust
Other Entity
Primary Beneficiary Name – 5
Phone Number
Address & Email
Social Security Number/Tax ID Date of Birth/Trust
% of Benefits
Per Stirpes
Complete Section 3 to designate
your Personal Representative.
If beneficiary is a minor provide the full name of responsible individual/UTMA/UGMA Custodian
Office Use Only:
Sub Firm # BR Code FA Code Account Number
578639 (Rev 21 - 09/21) Page 3 of 7
Type (select one)
Non-Spouse
Non-Spouse
-Minor
Trust
Other Entity
Primary Beneficiary Name – 6
Phone Number
Address & Email
Social Security Number/Tax ID Date of Birth/Trust % of Benefits
Per Stirpes
Complete Section 3 to designate
your Personal Representative.
If beneficiary is a minor provide the full name of responsible individual/UTMA/UGMA Custodian
Contingent Beneficiary
Contingent beneficiaries receive the assets if a Per Stirpes designation was not elected and the primary beneficiary(ies)
dies prior to you or disclaims.
Please provide the full legal name and beneficiary type for each listed beneficiary. Social Security number/Tax ID and
date of birth are recommended but not required and can be provided at any time. The Trust Date, other than a
testamentary trust, is required if a trust is designated as beneficiary.
Check “Per Stirpes” if you want the selected beneficiary’s share of the IRA to go to their lineal descendants (generally
children). This will only occur if you outlive the selected beneficiary or the beneficiary disclaims. If you select Per Stirpes,
please complete Section 3 to designate your Personal Representative.
If a beneficiary is a minor provide the full name of a responsible individual/designated UTMA/UGMA Custodian (does
not have to be the minor’s parent or legal guardian). If no designated UTMA/UGMA Custodian is named, the IRA
Custodian may require a designated UTMA/UGMA Custodian under UGMA/UTMA to be appointed by an authorized
court.
Total percentage of benefits for the listed contingent beneficiaries must equal 100%.
Type (select one)
Spouse
Non-Spouse
Non-Spouse
-Minor
Trust
Other Entity
Contingent Beneficiary Name – 1 (If naming a spouse, do so here.)
Phone Number
Address & Email
Social Security Number/Tax ID
Date of Birth/Trust
% of Benefits
Per Stirpes
Complete Section 3 to designate
your Personal Representative.
If beneficiary is a minor provide the full name of responsible individual/UTMA/UGMA Custodian
Type (select one)
Non-Spouse
Non-Spouse
-Minor
Trust
Other Entity
Contingent Beneficiary Name – 2
Phone Number
Address & Email
Social Security Number/Tax ID Date of Birth/Trust % of Benefits
Per Stirpes
Complete Section 3 to designate
your Personal Representative.
If beneficiary is a minor provide the full name of responsible individual/UTMA/UGMA Custodian
Office Use Only:
Sub Firm # BR Code FA Code Account Number
578639 (Rev 21 - 09/21) Page 4 of 7
Type (select one)
Non-Spouse
Non-Spouse
-Minor
Trust
Other Entity
Contingent Beneficiary Name – 3
Phone Number
Address & Email
Social Security Number/Tax ID
Date of Birth/Trust
% of Benefits
Per Stirpes
Complete Section 3 to designate
your Personal Representative.
If beneficiary is a minor provide the full name of responsible individual/UTMA/UGMA Custodian
Type (select one)
Non-Spouse
Non-Spouse
-Minor
Trust
Other Entity
Contingent Beneficiary Name – 4
Phone Number
Address & Email
Social Security Number/Tax ID Date of Birth/Trust % of Benefits
Per Stirpes
Complete Section 3 to designate
your Personal Representative.
If beneficiary is a minor provide the full name of responsible individual/UTMA/UGMA Custodian
Type (select one)
Non-Spouse
Non-Spouse
-Minor
Trust
Other Entity
Contingent Beneficiary Name – 5
Phone Number
Address & Email
Social Security Number/Tax ID Date of Birth/Trust % of Benefits
Per Stirpes
Complete Section 3 to designate
your Personal Representative.
If beneficiary is a minor provide the full name of responsible individual/UTMA/UGMA Custodian
Type (select one)
Non-Spouse
Non-Spouse
-Minor
Trust
Other Entity
Contingent Beneficiary Name – 6
Phone Number
Address & Email
Social Security Number/Tax ID Date of Birth/Trust
% of Benefits
Per Stirpes
Complete Section 3 to designate
your Personal Representative.
If beneficiary is a minor provide the full name of responsible individual/UTMA/UGMA Custodian
Office Use Only:
Sub Firm # BR Code FA Code Account Number
578639 (Rev 21 - 09/21) Page 5 of 7
Section 3: Personal Representative Designation, complete if applicable
If your beneficiary designations are included on a separate signed and dated document, you will need to include that
document with this form.
When submitting an additional document with your Beneficiary Designation or electing Per Stirpes you
will need to name a Personal Representative. Your Personal Representative is a named individual or a person
serving in the role of Executor/Executrix or Trustee. Your Personal Representative will provide the IRA Custodian with
any needed distribution instruction to be relied upon after your death. If the personal representative cannot serve, then
we may seek additional clarification. Please seek legal advice before making this election.
Provide the individual’s name or provide the role of either Executor/Executrix or Trustee
Section 4: Signature and Date
IRA holder or authorized individual must sign and date. By signing below, you agree to the following:
• The beneficiary designation for the indicated IRA replaces any prior beneficiary information.
• If per stirpes was selected, any named beneficiary’s share shall be payable to their surviving lineal descendants.
• If you have not provided percentages for each beneficiary, the IRA shall be divided equally among primary or
contingent beneficiaries.
• Unallocated amounts will be paid to the first named beneficiary when designations total at least 99% but less than
100%. In all other instances any unallocated amounts will be distributed on a pro rata basis among the primary or
contingent beneficiaries, as applicable.
• Fractional shares not distributable in accordance with your instructions will be given to the beneficiary receiving the
largest percentage of the IRA or, if each beneficiary is receiving an equal percentage, to the last to claim.
• If a designated beneficiary (including any contingent beneficiary) does not survive you, such beneficiary’s interest shall
lapse, and the percentage interest of any remaining beneficiary (including any contingent beneficiary) shall be increased
on a pro rata basis unless your beneficiary designation allows otherwise.
• If you do not have a valid beneficiary designation on file at the time of your death, the default provisions will be used in
accordance with the WFCS IRA Disclosure Statement and Custodial Agreement.
• If no designated UTMA/UGMA Custodian is named, the IRA Custodian may require a designated UTMA/UGMA
Custodian under UGMA/UTMA to be appointed by an authorized court.
• The beneficiary designation is not effective until the IRA Custodian has received and accepted this document.
Signature of IRA Holder or Authorized Individual
Signature Printed Name Date Signed
Office Use Only:
Sub Firm # BR Code FA Code Account Number
578639 (Rev 21 - 09/21) Page 6 of 7
Section 5: Spousal Consent (not required if establishing an Inherited IRA)
Your spouse should sign below if you live in a community, marital property jurisdiction, or elective share
state and you are not designating your spouse as your primary beneficiary. This includes but is not limited to
residents of AZ, CA, ID, NV, NM, PR, TX, WA, and WI. Note that in Alaska, community property rules may be adopted by
an agreement signed by the married couple. Some states may request different witness or notarization requirements. You
are solely responsible for determining if spousal consent is necessary and for determining if you have satisfied such state’s
consent requirements. If you do not have spousal consent when it is required, your spouse could assert his or her
community property rights to your IRA. Distribution of your IRA could be delayed, and we may require a court order
providing instructions on how to distribute your account.
Signature of IRA Holder's Spouse
Signature Printed Name Date Signed
Witness/Notary signature optional:
A notary and/or witness(es) are not required in order to complete this form. You should work with your legal counsel to
determine whether your state requires a notary and/or witness(es) in order for spousal consent to be valid. Our goal is to
make sure your wishes are followed when naming someone other than your spouse as your beneficiary. However, by not
working with legal counsel to determine your state's spousal consent requirements, your beneficiary designation to
someone other than your spouse may be challenged after your death.
Signature of Witness(es)
Signature Printed Name Date Signed
Signature Printed Name Date Signed
Notarization of Spousal Signature
State County
Subscribed and sworn to before me
This day of in the year
(Signature of Notary Public)
My commission expires:
Office Use Only:
Sub Firm # BR Code FA Code Account Number
578639 (Rev 21 - 09/21) Page 7 of 7
Return form to your Financial Advisor
For non-electronic signatures, Submit Form via Fax or Mail - Only for
WellsTrade and Intuitive Investors Clients
Ensure all sections are complete and that the form is signed and dated.
Fax: 844-879-1439
Mail: Wells Fargo Advisors, MAC N9160-01P, PO Box 77046, Minneapolis, MN 55480-9902
Questions: 1-800-872-3377
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IRA AddChange of Beneficiary

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Completed 8 March 2022

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