Exchange Form 1700 Beneficiary Designation

AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0702-0139, is estimated to average 20 minutes
per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding the burden estimate or burden reduction suggestions to the Department of defense, Washington
Headquarters Services, at [email protected]. Respondents
should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty
for failing to comply with a collection of information if it does not display a currently valid OMB control
number.

659, Consent by United States to Income Withholding, Garnishment, and Similar Proceedings for Enforcement
of Child Support and Alimony Obligations; 31 CFR 285.11, Administrative Wage Garnishment; DoD
Directive 7000.14-R, DoD Financial Management Regulation; DoD Instruction 1400.25, Volume 1408, DoD
Civilian Personnel Management System: Insurance and Annuities for Nonappropriated Fund (NAF)
Employees; Army Regulation 215-8/AFI 34-211(I). Army and Air Force Exchange Service Operations; and
E.O. 9397 (SSN), as amended.

with AAFES for specifics on life insurance beneficiaries.

http://dpcld.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx. Information may be released to
former spouses and/or survivors, to Federal, State, or Local Child Support agencies for purposes of
assisting in discharge of their responsibilites under Federal and State law.
payments to your elected beneficiaries.
A copy of the Privacy Impact Assessment (PIA) for the collection of information may be located at
https://www.aafes.com/about-exchange/public-affairs/FOIA/assessments.htm

EXCHANGE FORM 1700-012 (REV DEC 20)

OMB NO. 0702 0139
OMB approval expires
OCT 31, 2022

IMPORTANT: If you received credit for regular full time service as a civilian employee under the retirement plan of
another DoD NAFI and were subsequently hired by AAFES within 90 days after termination, then your service credit
under the prior NAFI Plan will count as Credited Civilian Service under the AAFES Plan in the same manner as for AAFES
employees. YOU MUST PROVIDE AAFES HQ BENEFITS TREASURY A COPY OF THE ACTION OF PRIOR NAFI RETIREMENT.
The following instructions are provided as a guidance for completing the following form.
1. Please read the Agency Disclosure Notice and Privacy Act Statement on the previous pages prior to completing
this form. If you have any questions please contact AAFES HQ Treasury Benefits at 800 519 3381.
2. SECTION I: Please provide all personal information at the top of the form where requested. Your Social Security
Number is required to locate all pertinent information for updating your records.
3. SECTION II: Complete all areas in this section ONLY if you wish for the SAME beneficiaries to share EQUALLY for
all programs. The beneficiary’s SSN is required for payment and tax purposes. Your choice for primary
beneficiary should be listed first. In the event this beneficiary is not living at the time of your death, a secondary
beneficiary should be listed on the second line. For each beneficiary you must provide full name, SSN, address,
date of birth and relationship. Should you require more room to provide your choice of beneficiaries, please
provide a separate page with all the requested information. Each additional page must be signed by you,
witnessed, and dated.
4. SECTION III: Complete all areas in this section ONLY if you wish to choose DIFFERENT beneficiaries for each
program. The beneficiary’s SSN is required for payment and tax purposes. Your choice for primary beneficiary
should be listed first. In the event this beneficiary is not living at the time of your death, a secondary beneficiary
should be listed on the second line. This section is divided into sub sections for each benefit program. For each
beneficiary in each sub section, you must provide full name, SSN, address, date of birth and relationship. Should
you require more room to provide your choice of beneficiaries, please provide a separate page with all the
requested information. Each additional page must be signed by you, witnessed, and dated.
5. SECTION III – PART F – 401(k): This section is required ONLY if you wish to provide a specific percentage of the
available benefit to each beneficiary. Otherwise, beneficiaries will share equally in available benefits.
6. When completed and signed in front of a witness, gather any required attachments and make a copy of all
documents for your records. Then mail the form and any attachments to AAFES HQ Treasury Benefits, P.O.
Box 650428, Dallas TX 75265 0428. AAFES HQ Treasury Benefits will update your beneficiary records.
7. Please read the next page providing you important considerations when choosing beneficiaries and providing
information on this form.
The information you provide on this form and any attachments, if signed and witnessed, will replace any previous
forms where you designated beneficiaries. If any page is not signed or if any page is not witnessed, it is not valid, and
all previous forms designating beneficiaries will remain in effect.

EXCHANGE FORM 1700 012 Instructions (REV DEC 20)

OMB NO. 0702 0139
OMB approval expires
OCT 31, 2022

IMPORTANT CONSIDERATIONS WHEN CHOOSING BENEFICIARIES
AND PROVIDING INFORMATION

benefits directly may be different in each state. A guardian, conservator, or other legal representative
may have to be appointed by a court to receive property on behalf of a minor. You, your estate or other
beneficiaries may be required to pay legal expenses to make these arrangements. If you designate a
beneficiary who is a minor child at the time of your death, the benefits will not be paid to that child
until your estate provides the insurance company with a copy of the court order appointing a guardian,
conservator, or other legal representative for that minor child.
To name a trust as beneficiary, please list the name and date of the Trust. Trust documents must be
attached and submitted with this form.
To name your estate as beneficiary, please list "My Estate."
A married female should be designated by her given first name,not by her spouse's given name. For
example, if you wish to list Mary e. Jones as your beneficiary, list her as Mary E. Jones, not
Mrs. John Jones.

EXCHANGE FORM 1700 012 Instructions (REV DEC 20)

PRINT OR TYPE ALL
INFORMATION
EXCEPT SIGNATURES

SEE PRIVACY ACT
STATEMENT
ON REVERSE

ARMY & AIR FORCE EXCHANGE SERVICE

BENEFICIARY DESIGNATION

NAME (Last, First, M.I.)

PRIOR NAME IF NAME CHANGED

CURRENT ADDRESS

SEX
M

SOCIAL SECURITY NO.

BIRTHDAY (Day, Mo, Yr)

COPY DIST:
Copy 1 - OPF
Copy 2 - EMPLOYEE
STATUS
ACT

MARITAL STATUS

F

RET

EMP STATUS
YES
NO

READ IMPORTANT NOTICES ON REVERSE SIDE
I - BENEFICIARY (Complete if you choose the same beneficiary(ies) for all programs).

I designate the following beneficiary(ies), or those surviving beneficiaries who are living at my death, to share equally any Unpaid Compensation,
Retirement Contributions, Life Insurance (Basic and Supplemental), EMP Life Insurance (EMPs only), or 401k Retirement Savings Plan
PERMANENT ADDRESS

BENEFICIARY NAME AND SOCIAL SECURITY NUMBER

BIRTHDATE (Day,Mo,Yr)

RELATIONSHIP

IF ALL OF THE ABOVE ARE NOT LIVING AT MY DEATH

ONLY

IF YOU WISH TO CHOOSE
OTHERWISE JUST COMPLETE PART I ABOVE.

II - COMPLETE BELOW

DIFFERENT

BENEFICIARIES FOR THE INDIVIDUAL PROGRAMS -

UNPAID COMPENSATION BENEFICIARY
DESIGNATION
BENEFICIARY
NAME AND SOCIAL SECURITY NUMBER

PERMANENT ADDRESS

BIRTHDATE (Day,Mo,Yr)

RELATIONSHIP

IF ALL OF THE ABOVE ARE NOT LIVING AT MY DEATH:

RETIREMENT CONTRIBUTIONS BENEFICIARY DESIGNATION
BENEFICIARY NAME AND SOCIAL SECURITY NUMBER

retirement contributions are payable to a designated beneficiary as long
( No
)
as benefits are actually or potentially payable to a surviving spouse.

PERMANENT ADDRESS

BIRTHDATE (Day,Mo,Yr)

RELATIONSHIP

BASIC LIFE INSURANCE BENEFICIARY DESIGNATION - (two times annual
PERMANENT ADDRESS
earnings)
BENEFICIARY NAME AND SOCIAL SECURITY NUMBER

BIRTHDATE (Day,Mo,Yr)

RELATIONSHIP

SUPPLEMENTAL LIFE INSURANCE BENEFICIARY DESIGNATION - (more than two times annual
earnings)
PERMANENT ADDRESS
BIRTHDATE (Day,Mo,Yr)
BENEFICIARY NAME AND SOCIAL SECURITY NUMBER

RELATIONSHIP

IF ALL OF THE ABOVE ARE NOT LIVING AT MY DEATH:

IF ALL OF THE ABOVE ARE NOT LIVING AT MY DEATH:

IF ALL OF THE ABOVE ARE NOT LIVING AT MY DEATH:

EXECUTIVE MANAGEMENT PROGRAM LIFE INSURANCE BENEFICIARY DESIGNATION
(Supplemental)
PERMANENT ADDRESS
BENEFICIARY NAME AND SOCIAL SECURITY NUMBER

BIRTHDATE (Day,Mo,Yr)

RELATIONSHIP

IF ALL OF THE ABOVE ARE NOT LIVING AT MY DEATH:

401k RETIREMENT SAVINGS PLAN BENEFICIARY DESIGNATION - PLAN NUMBER 83222. Use a whole % only.
PERMANENT ADDRESS

BENEFICIARY NAME AND SOCIAL SECURITY NUMBER

BIRTHDATE (Day,Mo,Yr)

RELATIONSHIP

%

IF ALL OF THE ABOVE ARE NOT LIVING AT MY DEATH:

I UNDERSTAND THAT THESE DESIGNATIONS OF BENEFICIARIES SHALL OPERATE SO AS TO REVOKE ALL PREVIOUS BENEFICIARY DESIGNATIONS MADE BY ME.

EMPLOYEE SIGNATURE

DATE (Day,Mo,Yr)

EXCHANGE FORM 1700-12 (REV DEC 20) (Prev Edition Obsolete)

WITNESS SIGNATURE (Other than beneficiary) DATE (Day,Mo,Yr)

PRIVACY ACT OF 1974
Utilization of your social security number and/or other
A copy of this action must be forwarded immediately to
personal information is authorized by Title 10, United
EXCHANGE HQ, ATTN: Benefits Development &
States Code, Sections 3013 and 8013. All information
Administration Branch (FA-T/B) when an employee attains
furnished is used to administer your employee insurance
RFT status within 90 days following separation for
through the payroll program which uses the social
"Reduction-in-Force" by another NAFI or when a RFT
security number as identification. Failure to provide
employee of another NAFI transfers to the Exchange
information would prevent your receiving proper benefits.
simultaneously with a transfer of function.
PRIOR NAFI SERVICE

BENEFICIARY DESIGNATIONS
1. If you wish for the same beneficiaries to share equally for all programs, complete Section I only. If you wish to
choose different beneficiaries for each program, complete Section II only. Take care to separate the primary
beneficiaries from those in the "If all of the above are not living at my death" line. Use a separate page (also

signed & witnessed) if necessary.
2. List the beneficiaries full name, SSN, address, DOB and relationship.
3. Beneficiaries share equally in all available benefits. (see note 7 for 401K only)
4. IMPORTANT: If minor children are named, the following should be considered.
The age at which a minor becomes eligible to inherit directly may vary from state to state. A guardian, conservator, or
other legal representative may have to be appointed by a court to receive property on behalf of a minor.
Accomplishing this may involve legal expense. A copy of the court order appointing said guardian, conservator, or
other legal representative must be furnished to the insurer after which the benefits will be paid to said individual on
behalf of the minor.
5. To name a trust as beneficiary: list name and date of the trust. Attach trust papers.
6. To name your estate as beneficiary: list "My Estate".
7. FOR 401k ONLY: Fill in this section if you want to specify the % amount to each beneficiary.
NOTE: A married female should be designated by her given first name, not by her husband's given name: Mary E.
Jones, not Mrs. John Jones.

NOTE: Print a copy of this form, complete, sign and give it to your HR office. Make sure a copy is put in your OPF
and keep a copy for your records. Unsigned and/or unwitnessed forms are not valid. Previous form on file will
remain in effect.

(REVERSE EXCHANGE FORM 1700-12)