Change of Beneficiary Form
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Member Number
*
Applicant Name
*
First
Last
Beneficiary Information
Beneficiary Name
Beneficiary Address
*
D.O.B
*
Relationship
*
Percentage
*
Add
Remove
Special Instructions
Witness Information
Witness Name
Witness Address
Member's Beneficiary Witness
Witness Signature
Clear Signature
Authorization
*
I do hereby authorize the change of any previous beneficiaries to the person(s) indicated above. The above mentioned person(s) shall be the only person(s) to or among whom shall be transferred my property in the Credit Union, whether shares deposits or otherwise upon my death, in such proportions as set forth above.
Member's Signature
*
Clear Signature
Submit