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Run: Beneficiary Designation Form

Capture who should receive benefits, how they’re split, and what happens if a primary beneficiary can’t be paid. This form helps HR and plan participants kee...

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Participant Information

Full Name (required)

Employee ID (required)

Department

Contact Email (required)

Primary Beneficiary

Primary Beneficiary Full Name (required)

Relationship to Participant (required)

Allocation Percentage (required)

Enter the percentage of benefits assigned to this primary beneficiary.

Date of Birth

Mailing Address

Contingent Beneficiary

Contingent Beneficiary Full Name

Relationship to Participant

Allocation Percentage

Enter the percentage of benefits assigned to this contingent beneficiary.

Date of Birth

Mailing Address

Designation Details

Designation Type (required)

Replace all prior beneficiary designations

Yes No N/A

Effective Date (required)

Special Instructions

Acknowledgment and Signature

Acknowledgment (required)

I confirm that the information provided is true and complete, and I understand this designation will supersede prior instructions when accepted.

Yes No N/A

Signature (required)

Date Signed (required)

Witness Name

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Email (required)

Your name (optional)

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