Enrollment Beneficiary - Retirement Services

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Beneficiary Designations

Do you want to designate your beneficiaries at this time? Yes No

Primary Beneficiaries

Click the

to add beneficiaries.

Primary Beneficiary - 1

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Primary Beneficiary - 2

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Primary Beneficiary - 3

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Primary Beneficiary - 4

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Primary Beneficiary - 5

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Primary Beneficiary - 6

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Primary Beneficiary - 7

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Primary Beneficiary - 8

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Primary Beneficiary - 9

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Primary Beneficiary - 10

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Total
%

Contingent Beneficiaries

Click the

to add beneficiaries.

Contingent Beneficiary - 1

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Contingent Beneficiary - 2

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Contingent Beneficiary - 3

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Contingent Beneficiary - 4

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Contingent Beneficiary - 5

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Contingent Beneficiary - 6

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Contingent Beneficiary - 7

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Contingent Beneficiary - 8

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Contingent Beneficiary - 9

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Contingent Beneficiary - 10

Percentage
% %

Name (full first and last)

SSN/TIN
XXX-XX-

Type of beneficiary

Address Line 1

Address Line 2

City

State

Zip

Date of birth (mm/dd/yyyy)
XX/XX/

Relationship to Participant

Total
%

I designate the above person(s), organization(s) and/or trust(s) as the beneficiaries of my plan account payable in the event of my death.

See below for important information about designating beneficiaries.

	Beneficiary FAQs

	Download Blank Beneficiary Form

Beneficiary Information >>

IMPORTANT: If you submitted your beneficiary designations via paper form, you will not be able to view the information here, unless you also entered the information online. To verify your current beneficiary designations, call 866-715-3552 Option 3, or send an e-mail to contact_center@insperity.com.

If you do not designate a beneficiary and you are:

Married - your spouse is automatically your sole primary beneficiary.
NOT married - your beneficiary will be your estate.

Should any designated Primary or Contingent Beneficiary predecease you, that beneficiary's award will be allocated pro rata among the remaining living beneficiaries within the same applicable class of beneficiaries, if any.

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