Account Beneficiary Designation/Update

* Indicates Required

• This form will supersede any previous beneficiary designation you may have on record with ActorsFCU for the disposition of your ActorsFCU accounts. This form is not accepted for any IRA; please complete the IRA Beneficiary form.

  • Complete all the information requested [being thorough will help us locate your beneficiary(ies) when necessary].
  • Beneficiaries may be an individual(s) or a Trust. ActorsFCU does not offer contingent beneficiaries.

  ACCOUNT INFORMATION

  Account Owners own account in equal parts. Beneficiaries do not become effective until ALL account owners have expired.

  Member Number*

  Email*

  Phone *

  Number of Account Owners *

  1 2 3 4

  Number of Account Owners is required.

  ALL ACCOUNT OWNERS MUST BE LISTED BELOW.

  Member Complete Legal Name*

  Co-Owner 1 Complete Legal Name*

  Co-Owner 2 Complete Legal Name*

  Co-Owner 3 Complete Legal Name*

  By agreeing, I represent that all account owners are aware of and in agreement with the changes being requested. As such, Actors FCU is held harmless to any direct/indirect claims made in connection with this request, now or in the future.

  I agree*

• BENEFICIARIES

  Number of Beneficiaries *

  1 2 3 4

  Number of Beneficiaries is required.

  ---

  Beneficiary 1

  First, Middle, and Last Legal Name OR Trust Name*

  Social Security Number*

  Date of Birth (for Individuals)

  Physical Address (Include Unit # – P.O. Box NOT accepted)*

  City*

  State*

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip Code*

  Contact Phone Number*

  Percentage*

  %

  All percentages for beneficiaries must add to 100%.

  Relationship to Account Owner*

  ---

  Beneficiary 2

  First, Middle, and Last Legal Name OR Trust Name*

  Social Security Number*

  Date of Birth (for Individuals)

  Physical Address (Include Unit # – P.O. Box NOT accepted)*

  City*

  State*

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip Code*

  Contact Phone Number*

  Percentage*

  %

  All percentages for beneficiaries must add to 100%.

  Relationship to Account Owner*

  ---

  Beneficiary 3

  First, Middle, and Last Legal Name OR Trust Name*

  Social Security Number*

  Date of Birth (for Individuals)

  Physical Address (Include Unit # – P.O. Box NOT accepted)*

  City*

  State*

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip Code*

  Contact Phone Number*

  Percentage*

  %

  All percentages for beneficiaries must add to 100%.

  Relationship to Account Owner*

  ---

  Beneficiary 4

  First, Middle, and Last Legal Name OR Trust Name*

  Social Security Number*

  Date of Birth (for Individuals)

  Physical Address (Include Unit # – P.O. Box NOT accepted)*

  City*

  State*

  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

  Zip Code*

  Contact Phone Number*

  Percentage*

  %

  All percentages for beneficiaries must add to 100%.

  Relationship to Account Owner*

  
  

• Signatures

  The undersigned agree to the terms stated on this form as a designation/update to the Account Agreement governing the account referenced above, and also agree to the beneficiary(ies) designation/update indicated. The undersigned also agree to the terms stated in the separate Account Agreement and Disclosures and Fee Schedule, and acknowledge their receipt.

  Member Name *

  Date*

  Member Signature*

  Clear Signature

  Co-Owner 1 Name *

  Date*

  Co-Owner 1 Signature *

  Clear Signature

  Co-Owner 2 Name *

  Date*

  Co-Owner 2 Signature *

  Clear Signature

  Co-Owner 3 Name *

  Date*

  Co-Owner 3 Signature *

  Clear Signature

  
  

  To verify your identity, please attach a valid ID below *

  Accepted ID types include: government issued photo ID, i.e.: State issued driver's license, US passport, or equivalent.

  An Attachment is required.

  Select files from your computer
  or simply drag & drop them here

  Accepted formats: .pages, .doc, .docx, .pdf, .png, .jpg.