Form 707 Designation of Beneficiary for Benefits Owed at Death

Locating and Paying Participants

e_Form 707 Designation of Beneficiary for Benefits Owed at Death

Locating and Paying Participants

OMB: 1212-0055

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Designation of Beneficiary for Benefits Owed at Death

(Currently Receiving Pension Benefits)


PBGC Form 707


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: 01/14/2021



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



INSTRUCTIONS: Use this form to name your beneficiary. If you have any questions, please 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 for Benefits Owed at Death

Form 707, page 2 of 2


(Currently Receving Pension Benefits)



Plan Number: FX.PrismCase.CaseIdNmbr.XF

Participant Name: FX.PrismCust.FullName.XF

3. Designation of Beneficiary for Payments Owed at Death PBGC may owe you money at the time of your death. Typically, this happens if your final benefit is higher than the estimated benefit we had been paying. If another person continues to receive your benefit after your death (as with a joint-and-survivor or certain-and-continuous annuity), PBGC will pay any money owed to that person. If there are no continuing benefits or the person designated to receive continuing benefits dies before you, PBGC will pay any money owed you at the time of your death to the person(s) and/or entity(ies) (such as a trust, church, estate or other organization) that you designate in this section. If you do not make a designation, or if all the beneficiaries you designate below die before you, PBGC will pay the money 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:







Shape6 Shape5 Name

Shape7 Address

Shape8

Shape9 Daytime Tel. No:







Shape11 Shape10 Name

Shape12 Address

Shape13

Shape14 Daytime Tel. No:






* Complete if person

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




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleDesignation of Beneficiary PBGC Form 707
AuthorPBGC\IOD
File Modified0000-00-00
File Created2021-01-14

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