PERSONAL INFORMATION Title ---ReverendDr.Mr.Mrs.Ms. U.S. Citizen ---YesNo Marital Status ---MarriedSingleWidow(er)Divorced Gender ---MaleFemale BENEFICIARIES Primary Beneficiary I designate the following as my PRIMARY beneficiary: Must be Spouse (and only spouse) if married unless waiver filed. If unmarried and would like to designate an additional primary beneficiary(ies), please provide their information below and indicate the percentage for each primary beneficiary. Contingent Beneficiary I designate the following CONTINGENT beneficiary(ies). (In the event the primary beneficiary is deceased, the contingent beneficiary(ies) will receive the funds in the account) CERTIFICATION I request that the beneficiary information provided above be updated on my account. Use your mouse (or finger if on a mobile device) to sign your name in the box below.