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DEER PARK INDEPENDENT SCHOOL DISTRICT_DEER PARK INDEPENDENT
Updated:2011-12-31 Category:School
Snapshot of the Word file:"DEER PARK INDEPENDENT SCHOOL DISTRICT_DEER PARK INDEPENDENT SCHOOL DISTRICTLIFE INSURANCE☐Check here if this is a chan".doc

DEER PARK INDEPENDENT SCHOOL DISTRICT

LIFE INSURANCE

☐Check here if this is a change

Employee NameSocial Security No.

DESIGNATION OF BENEFICIARY

PRIMARY BENEFICIARY OR JOINT PRIMARY BENEFICIARIES I hereby designate the following person(s) as my primary beneficiary(ies) to receive any payments which may be due following my death (joint beneficiaries to share and share alike, with right of survivorship only): NAME SOCIAL SECURITY # BIRTHDATE RELATIONSHIP ALTERNATE BENEFICIARY OR JOINT ALTERNATE BENEFICIARIES Only in the event I live longer than the primary beneficiary(ies) name above, I designate the following person(s) as my alternate beneficiary(ies) to receive any payments which may be due following my death (joint alternate beneficiaries to share and share alike, with right of survivorship only): NAME SOCIAL SECURITY # BIRTHDATE RELATIONSHIP

Your SignatureDate

Complete and Return to Gail Crosslin – Ad. Bldg.

To change the designation of beneficiary with TRS you

MUST call 1-800-223-8778.

s://FORMS/Designation of Beneficiary.doc7/16/2007


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