IBEW LOCAL NO. 1

Bylaws Death Benefit - Beneficiary Designation Form

Member Information

Primary Beneficiary (Up to 3)

(Example: Mary A. Doe not Mrs. Joel J. Doe)

Primary Beneficiary 1

Primary Beneficiary 2

Primary Beneficiary 3

Contingent Beneficiary (Up to 3)

Contingent Beneficiary 1

Contingent Beneficiary 2

Contingent Beneficiary 3

Authorization

Benefit will be paid first to the person paying or providing for funeral and burial; any remaining benefit will be paid to the first of the following categories in which there is a person surviving the member: designated beneficiary, spouse, children, parents, siblings, estate.