707 Designation of Beneficiary

	Designation of Beneficiary (Currently Receiving Pension Benefits)		PBGC Form 707 Approved OMB 1212-0055 Expires 08/31/08
Pension Benefit Guaranty Corporation. P.O. Box 151750 Alexandria Virginia 22315-1750		For assistance, call 1-800-400-7242

	Case Name: «PrismCase.CaseTitle»
	Case Number: «PrismCase.CaseIdNmbr»	Participant Name: «PrismCust.FullName»
	Date Printed: 02/06/2021	Applicant Name / SSN:
	Date of Plan Termination: «PrismCase.DOPT»

INSTRUCTIONS: Use this form to name or change your beneficiary. Be sure to print clearly and use dark ink. If you have any questions, please call our Customer Contact Center at 1-800-400-7242.

1. General information about you

Last Name

First Name

Middle Name

Other Name(s) Used

Social Security Number

-

-

Mailing Address

Apartment / Route Number

City

State

Zip Code

Country

Email (optional)

Daytime Phone

Extension

Evening Phone

(

)

-

x

(

)

-

2. Beneficiary Designation – Please indicate the type of designation you are making. If you want to designate different persons to receive the two types of payments, please use a separate form for each. If you want to designate the same person, check both boxes. If the beneficiary you name dies before you, PBGC will pay the amount we owe you in this order: your spouse, your children, your parents, your estate, and your next of kin.

	Designation of Beneficiary for Annuity Benefits Payable after Death – Annuity benefits, other than joint-and-survivor benefits, that are payable to your beneficiary for periods after your death.
	Designation of Beneficiary for Benefits Due at Death – This designation covers payments that PBGC may owe you at the time of your death such as back payments for benefit estimates that were too low. If your benefit continues after your death (as with a joint-and-survivor or certain-and-continuous annuity), the person named to receive those continuing benefits will receive any payments due to you at the time of your death. If not, PBGC will make any payments due to you at the time of your death to the person you name below. If you do not name anyone, or if the beneficiary you name dies before you, PBGC will pay the amount we owe you in this order: your spouse, your children, your parents, your estate and your next of kin.
	CONTINUE

Designation of Beneficiary (Currently Receiving Pension Benefits) Form 707, page 2 of 2
	Case : «PrismCase.CaseIdNmbr»	Participant Name: «PrismCust.FullName»
		Applicant Name / SSN:

3. Beneficiary – I name the following person as my beneficiary for the purpose checked in #2. This designation replaces any previous designation and will only be effective when PBGC receives it.

Last Name

First Name

Middle Name

Other Name(s) Used

Social Security Number

Date of Birth

Gender

male 

-

-

/

/

female 

Mailing Address

Apartment / Route Number

City

State

Zip Code

Country

Email (optional)

Daytime Phone

Extension

Evening Phone

(

)

-

x

(

)

-

Relationship to me, if any (e.g., spouse, granddaughter, friend)

4. Contingent beneficiary – If the person I listed in section 3 dies before I do, I name the following person as my contingent beneficiary.

Last Name

First Name

Middle Name

Other Name(s) Used

Social Security Number

Date of Birth

Gender

male 

-

-

/

/

female 

Mailing Address

Apartment / Route Number

City

State

Zip Code

Country

Email (optional)

Daytime Phone

Extension

Evening Phone

(

)

-

x

(

)

-

Relationship to me, if any (e.g., spouse, granddaughter, friend)

4. Signature – You must sign and date this form.

signature

date

SIGN & DATE BEFORE SUBMITTING. THANK YOU.