Form 708 Designation of Beneficiary for Benefits Owed at Death (N

Designation of Beneficiary

PBGC Form 708

(Not 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 designate your beneficiary(ies) for payments owed at death. 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.
Do not use this form to change your beneficiary if you are receiving pension benefits. Use PBGC Form 707.

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
Form 708, page 2 of 2

(Not Currently Receiving Pension Benefits)
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***

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.

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