Form 707 Designation of Beneficiary for Benefits Owed at Death (C

Designation of Beneficiary for
Benefits Owed at Death

PBGC Form 707

(Currently Receiving Pension Benefits)
Pension Benefit Guaranty Corporation.
P.O. Box 151750, Alexandria, Virginia 22315-1750
Plan Name: FX.PrismCase.CaseTitle.XF
Plan Number: FX.PrismCase.CaseIdNmbr.XF
Date Printed: 07/07/2021
Date of Plan Termination: FX.PrismCase.DOPT.XF

For assistance, call 1-800-400-7242
Participant Name: FX.PrismCust.FullName.XF

INSTRUCTIONS: Use this form to name or change your beneficiary(ies) for payments owed at death. 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) If you are receiving a certain-and-continuous annuity, you may not use this form to change your beneficiary for the certain
period. You may use PBGC Form 711.
2) If you are receiving payments in a joint-and-survivor annuity, you may not change your survivor annuity beneficiary for
continuing payments

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

Country

Email

Daytime Phone

(

Extension

)

-

x

Zip Code

Evening Phone

(

)

-

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 _______

Designation of Beneficiary for Benefits Owed at Death
(Currently Receiving Pension Benefits)
Plan Number: FX.PrismCase.CaseIdNmbr.XF

Form 707, page 2 of 2

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***

Name _______________________________________
Address ______________________________________
_____________________________________________
Daytime Tel. No:_______________________________

Name _______________________________________
Address ______________________________________
_____________________________________________
Daytime Tel. No:_______________________________

Name _______________________________________
Address ______________________________________
_____________________________________________
Daytime Tel. No:_______________________________

*To name more beneficiaries, please list them with requested contact info, DOB and SSN on an attached sheet with your
signature.
**Complete if person.
*** Percentage(s) does not have to be provided.
The amount owed will be distributed equally among beneficiaries unless percentages are provided for each beneficiary and they total 100%.
If a beneficiary dies before you, the amount owed will be distributed equally among the remaining beneficiaries.