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301 / 2303 (Rev. 4/2015) ©2015 Ascensus, Inc.
PART 1. IRA OWNER
Name (First/MI/Last) __________________________________________
Social Security Number ________________________________________
Date of Birth ____________________ Phone ______________________
Email Address ________________________________________________
Account Number__________________________________ Sux ______
ACCOUNT TYPE (Select one)
Tradional IRA         Roth IRA         SIMPLE IRA
PART 2. IRA TRUSTEE OR CUSTODIAN
To be completed by the IRA trustee or custodian
Name ______________________________________________________
Address Line 1 _______________________________________________
Address Line 2 _______________________________________________
City/State/ZIP ________________________________________________
Phone________________________ Organizaon Number ____________
CONTINGENT BENEFICIARIES on page 2
PART 3. BENEFICIARY DESIGNATION
I designate that upon my death, the assets in this account be paid to the beneciaries named below. The interest of any beneciary that predeceases
me terminates completely, and the percentage share of any remaining beneciaries will be increased on a pro rata basis. If no beneciaries are named,
my estate will be my beneciary.
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
PRIMARY BENEFICIARIES (The total percentage designated must equal 100%. If more than one beneciary is designated and no percentages are
indicated, the beneciaries will be deemed to own equal share percentages in the IRA.)
BENEFICIARY DESIGNATION
This beneciary designaon overrides all previous designaons for this IRA. The term IRA will be used below to mean Tradional
IRA, Roth IRA, and SIMPLE IRA, unless otherwise specied.
IRA
Kinecta Federal Credit Union
Attn: Member Service Support
1440 Rosecrans Ave.
Manhattan Beach, CA 90266
(800) 854-9846
11379
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301 / 2303 (Rev. 4/2015) ©2015 Ascensus, Inc.
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
Name _______________________________________________________
Address ____________________________________________________
City/State/ZIP ________________________________________________
Date of Birth _________________ Relaonship ____________________
Tax ID (SSN/TIN) ____________________ Percent Designated _________
CONTINGENT BENEFICIARIES(The total percentage designated must equal 100%. If more than one beneciary is designated and no percentages
are indicated, the beneciaries will be deemed to own equal share percentages in the IRA. The balance in the account will be payable to these
beneciaries if all primary beneciaries have predeceased the IRA owner.)
PART 4. SPOUSAL CONSENT
Spousal consent should be considered if either the trust or the residence of
the IRA owner is located in a community or marital property state.
CURRENT MARITAL STATUS
I Am Not Married – I understand that if I become married in the
future, I should review the requirements for spousal consent.
I Am Married – I understand that if I choose to designate a primary
beneciary other than or in addion to my spouse, my spouse should
sign below.
CONSENT OF SPOUSE
I am the spouse of the above-named IRA owner. I acknowledge that I have
received a fair and reasonable disclosure of my spouse’s property and
nancial obligaons. Because of the important tax consequences of giving
up my interest in this IRA, I have been advised to see a tax professional.
I hereby relinquish any interest that I may have in this IRA and consent to
the beneciary designaon indicated above. I assume full responsibility for
any adverse consequences that may result.
X____________________________________________ ____________________
Signature of Spouse Date (mm/dd/yyyy)
X____________________________________________ ____________________
Signature of Witness Date (mm/dd/yyyy)
PART 5. SIGNATURES
I understand that I may replace my beneciary designaons at any me by
compleng and delivering the proper form to the trustee or custodian.
The trustee or custodian has provided no tax or legal advice to me
regarding my beneciary designaons.
I designate the persons or enes named above as my primary and/or
conngent beneciaries of this IRA. I hereby revoke all prior beneciary
designaons, if any, made by me.
X____________________________________________ ____________________
Signature of IRA Owner Date (mm/dd/yyyy)
X____________________________________________ ____________________
Signature of Witness Date (mm/dd/yyyy)
Check here if addional beneciaries are listed on an aached addendum. Total number of addendums aached to this IRA _______________
Name of IRA Owner ______________________________________________________________, Account Number ______________________________