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Run: Payable-on-Death Beneficiary Designation Form

Use this Payable-on-Death Beneficiary Designation Form to name who receives a deposit account after the account holder’s death, with space for primary and co...

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Account Holder Information

Account Holder Full Name (required)

Deposit Account Number (Last 4 Digits) (required)

Enter only the last 4 digits to support data minimization.

Account Type (required)

Contact Email

Optional. Used only if the institution needs to follow up about this designation.

Designation Details

What would you like to do? (required)

Effective Date (required)

The date you want this designation request to take effect.

Is this a joint account? (required)

Joint Owner Consent (required)

Confirm that all required joint owners have consented to this designation, if applicable.

Yes No N/A

Primary Beneficiaries

Primary Beneficiaries (required)

Beneficiary Details

Beneficiary Full Name (required)

Relationship to Account Holder (required)

Allocation Percentage (required)

Enter a whole number percentage. All primary beneficiaries should total 100%.

Beneficiary Date of Birth

Optional unless needed to distinguish between beneficiaries with similar names.

Beneficiary Mailing Address

Optional. Collect only if required by your institution's policy or for identity verification.

Contingent Beneficiaries

Would you like to add contingent beneficiaries? (required)

Contingent Beneficiaries

Consent, Disclosure, and Certification

I acknowledge that POD designations may be governed by account agreement terms and applicable law. (required)

Yes No N/A

I consent to the collection and use of the personal information provided in this form for beneficiary designation processing. (required)

Yes No N/A

Certification (required)

Sign to certify that the information provided is accurate and that you are authorized to make this request.

Additional Notes

Optional. Use this field only for information relevant to processing this designation.

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Email (required)

Your name (optional)

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