Form 708 Designation of Beneficiary

Locating and Paying Participants

e_Form 708 Designation of Beneficiary

Locating and Paying Participants

OMB: 1212-0055

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Designation of Beneficiary

(Not Currently Receiving Pension Benefits)



PBGC Form 708


Pension Benefit Guaranty Corporation.
P.O. Box
151750, Alexandria, Virginia 22315-1750

For assistance, call 1-800-400-7242



Plan Name: FX.PrismCase.CaseTitle.XF


Plan Number: FX.PrismCase.CaseIdNmbr.XF

Participant Name: FX.PrismCust.FullName.XF


Date Printed: 01/24/2021



Date of Plan Termination: FX.PrismCase.DOPT.XF


INSTRUCTIONS: Use this form to designate your beneficiary. To begin receiving benefits, or for other information, call our Customer Contact Center at 1-800-400-7242. Please print clearly with blue or black ink.


1. General information about you


Last Name

First Name

Middle Name

Other Last Name(s) Used


Social Security Number





-



-






Mailing Address

Apartment / Route Number

City

State

Zip Code

Country

Email


Daytime Phone

Extension

Evening Phone

(




)




-





x





(




)




-







2. Signature Sign and date this document. Knowingly and willfully making false, fictitious or fraudulent statements to the Pension Benefit Guaranty Corporation is a crime punishable under Title 18, Section 1001, United States Code.


I declare under penalty of perjury that all of the information I have provided on this form is true and correct.


signature



date





CONTINUE ON BACK











Approved OMB 1212-0055

Expires xx/xx/xx


Designation of Beneficiary

(Not Currently Receiving Pension Benefits)


Form 708, page 2 of 2


Plan Number: FX.PrismCase.CaseIdNmbr.XF

Participant Name : FX.PrismCust.FullName.XF






3. Designation of Beneficiary for Payments Owed at Death – If there are payments owed to you at the time of your death, PBGC will pay them to the person(s) and/or entity(ies) (such as a trust, church, estate or other organization) that you designate below. If you do not make a designation, or if all the beneficiaries you designate below die before you, PBGC will pay any money we owe you in this order to: your spouse, your children, your parents, your estate, or your next of kin.


I name the following as my beneficiary(ies). This designation replaces any previous designation and will only be effective when PBGC receives it.


Beneficiary(ies)

Social Security Number*

Date of Birth*

Relationship

Percentage**



Shape1 Name

Shape2 Address

Shape3

Shape4 Daytime Tel. No:







Shape5 Name

Shape6 Address

Shape7

Shape8 Daytime Tel. No:







Shape9 Name

Shape10 Address

Shape11

Shape12 Daytime Tel. No:






* Complete if person

** Not necessary to provide; if provided, must total 100%


SIGN & DATE ON PAGE 1 BEFORE SUBMITTING. THANK YOU.


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleGeneral Information Form_PBGC Form XXX
AuthorPBGC\IOD
File Modified0000-00-00
File Created2021-01-24

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