consisting of 100% of your vested account balance to your surviving spouse (if any) as beneficiary.

Transcription

1 Instructions and PESP Rules for Beneficiary Designations RETAIN FOR YOUR RECORDS Participant s Federal law provides certain rights and death benefits to spouses of participants in qualified retirement plans like PESP. The following describes the spousal death benefit your spouse is entitled to under PESP and your spouse s rights with Spousal regard to this benefit. Death Benefit Generally, if you die before you begin to receive benefits, PESP must automatically pay a spousal death benefit (not applicable to consisting of 100 of your vested account balance to your surviving spouse (if any) as beneficiary. Beneficiaries or Waiving the spousal death benefit Alternate Payees under QDROs) Upon your death, generally your spouse will be paid 100 of your vested PESP account balance, unless you designate someone other than your spouse, or in addition to your spouse, as Primary Beneficiary and your spouse provides written and notarized consent to your election. You cannot have some or all of the spousal death benefit paid to someone else unless your spouse agrees and signs this form in the presence of a notary public. Your spouse s choice must be voluntary. It is his or her personal decision whether he or she wants to give up his or her right to your some or all of the spousal death benefit. Your spouse cannot change this form after signing it. His or her decision is final. Legal separation or divorce may end your spouse s right to some or all of the spousal death benefit even if he or she does not sign this form. However, if you become legally separated or divorced, your spouse might be able to get a special court order (which is called a qualified domestic relations order or QDRO ) that specifically protects his or her rights to some or all of the spousal death benefit. If you or your spouse is thinking about separating or getting a divorce, you both should get legal advice on the rights each of you has to benefits under PESP. Even if your PESP beneficiary designation is a trust or estate of which your spouse is a beneficiary, waiver of the spousal death benefit and written and notarized spousal consent is necessary. Without proper spousal consent to your designation of a non-spouse Primary Beneficiary, the spousal death benefit under PESP must be paid directly to your spouse. You may designate a new PESP beneficiary at any time before your death, to the extent permissible under applicable law, by submitting a new PESP Beneficiary Designation Form. However, any subsequent designation of a non-spouse Primary Beneficiary would require your spouse s written and notarized consent. Since a waiver is valid only for the spouse consenting to the waiver, if you later remarry, you must complete a new PESP Beneficiary Designation Form and obtain your new spouse s written and notarized consent or your new spouse will automatically become your sole Primary Beneficiary. It is important that you and your spouse understand the rights and obligations concerning the PESP spousal death benefit. You should each consult your legal, tax and/or financial advisor to determine what is best for your particular situation before you take any action. General A. Provisions B. C. D. E. F. Ed. 7/2004 The terms of PESP govern the payment of any benefit. Primary Beneficiary(ies): If more than one person is named and no percentages are indicated, payment will be made in equal shares to the Primary Beneficiary(ies) who is living at the time the benefit first becomes payable. Generally, if a percentage is indicated and a Primary Beneficiary(ies) is not alive at the time the benefit first becomes payable, the percentage of that beneficiary's designated share will be divided on a pro rata basis among the surviving Primary Beneficiary(ies) based on their relative account percentages. If there is no Primary Beneficiary(ies) living at the time of the Participant's death, any benefit that becomes payable will be distributed to the surviving Secondary Beneficiary(ies), if applicable. Payment to Secondary Beneficiary(ies) will be made according to the rules of succession described under Primary Beneficiary(ies) in provision B above. If no designated Beneficiary(ies) is alive when payment is otherwise payable, payment will be made in accordance with PESP. If you are single and do not complete the form correctly or if all your Beneficiaries die before you do, your Beneficiary will automatically be your estate. If you are a Participant and you are married, generally, your surviving spouse is automatically your Beneficiary, as required by law. The terms of PESP shall govern the use of any affidavit or other satisfactory written evidence in determining the existence, identity, ages or any other facts concerning any Beneficiary(ies). Important information continued on the following page

2 G. If you have chosen an annuity form of distribution, once annuity payments have begun, any settlement of any General amount thereafter payable shall be governed by the terms of such annuity. Provisions (continued) H. If a trustee is named as Beneficiary, any payment to the trustee will be made as if the trustee is acting in such fiduciary capacity until written notice to the contrary is received. (See Examples of Beneficiary Designations section below.) If you name a trust as your beneficiary, you must also complete, sign, and return the attached Trust Certification Form. Examples of 1. Beneficiary Designations I. Prudential shall pay the trustee(s) named under a last will and testament only if: 1) the last will and testament is admitted to probate and appoints a trustee(s) to receive such payment, and 2) the trustee(s) qualifies as such. (See Examples of Beneficiary Designations section below.) J. The Beneficiary(ies) may be changed to the extent permissible under applicable law, but only in a manner that is in accordance with PESP. K. Any benefit that will be payable upon your death will be made to the person(s) named on the attached Beneficiary Designation Form. Please be careful in completing the form; be sure that your designation is accurate, clear and understandable. L. Further instructions and examples are provided below, but you and your spouse should each consult your legal, tax and/or financial advisor to determine what is best for your particular situation before you take any action. M. If it is determined by the PESP Administrative Committee established under the terms of PESP that a Beneficiary entitled to payment from PESP is physically or mentally incapable of personally receiving and providing a valid receipt for the payment, and no claim for the payment has been made by a qualified guardian, conservator, or committee of such Beneficiary, the PESP Administrative Committee may authorize that the payment such Beneficiary is entitled to under PESP instead be made to the person or institution contributing toward or providing for the care or maintenance of such Beneficiary. Any such payment shall completely discharge all liability with respect to the amount paid. N. If the following occur, the Administrative Committee shall act in a manner consistent with the common or statutory law described in (ii) below such that the Beneficiary responsible for the death of the Participant shall not receive benefits under PESP: (i) a Participant is killed by a Beneficiary; (ii) the common or statutory law of the state, territory or other governmental subdivision in which such Participant resided immediately prior to his or her death provides that the Beneficiary responsible for the death of the Participant is treated as predeceasing the Participant or is otherwise treated as ineligible to receive a benefit from a type of plan including PESP; and (iii) the Administrative Committee has knowledge of the circumstances described in (i) and (ii) above. If any of the above conditions are not satisfied, such payment shall be payable according to the terms of PESP. 2. Use the term "My Living Trust" if you want to designate your living trust. Use the term "My Testamentary Trust" if you want to designate the trust in your last will and testament. Either of these terms can be used in the Primary and/or Secondary Beneficiary sections. For either of the above trust beneficiary designations to take effect, the Participant must also complete, sign, and return the attached "Trust Certification Form." It is important to note that when you designate a trust as your beneficiary, if there are any changes to the information on the Trust Certification Form, you must also complete revised Beneficiary Designation and Trust Certification Forms. The trustee must provide the PESP Administrative Committee or its delegate, with a final list of all beneficiaries of the trust by October 31 of the year following the Participant's death. Use the term "My Estate" if you want the benefit to be paid to your estate. This term can be used in the Primary and/or Secondary Beneficiary sections. If you know your intended executor, include the executor s name and address. DID YOU REMEMBER TO: Sign the form Have spouse s signature witnessed by a notary public (if necessary) Initial any alterations

3 Beneficiary Designation Form Instructions About You Please print using blue or black ink. Keep a copy for your records and send completed form to either of the following: Questions? Fax: If faxing, please keep original for your records. Call PRU-EASY ( ) for Mail: Prudential Retirement - PESP Team assistance. 30 Scranton Office Park If you are hearing impaired and have a teletype (TTY) Scranton, PA line, call Plan number Please indicate what type of account this is: Employee Spousal Beneficiary Non-Spousal Beneficiary Alternate Payee under Qualified Domestic Relations Order (QDRO) Social Security number Daytime telephone number area code First name MI Last name Marital status: Married Single, widowed or divorced Your Please refer to the attached Instructions and PESP Rules for Beneficiary Designations for instructions and examples of Beneficiary how to complete your PESP beneficiary designation. Designation Married participants must complete A or B (A) I designate my spouse as my sole Primary Beneficiary to receive 100 of my vested PESP account balance upon my death. (Please provide Primary Beneficiary information for your spouse under Section I below and complete Section II below if you wish to make a Secondary Beneficiary designation.) OR (B) I have read the attached Instructions and PESP Rules for Beneficiary Designations including the section regarding the spousal death benefit. I understand the terms of the spousal death benefit and designate the following individual(s) as my Primary Beneficiary(ies) to receive some or all of my vested PESP account balance upon my death instead of designating my spouse as my sole Primary Beneficiary. I understand that my spouse s written and notarized consent is required for this beneficiary designation to take effect and that I may change my PESP beneficiary designation at any time in accordance with the terms of PESP and to the extent permissible under applicable law. (Please provide Primary Beneficiary(ies) information under Section I below and complete Section II below if you wish to make a Secondary Beneficiary designation.) Ed. 7/2004 Important information continued and signature required on the following page

4 Your You must complete Section I, and Section II, if applicable. If you name a trust as your beneficiary, you must also complete, sign, and return the attached Trust Certification Form. Beneficiary Designation Please provide the full legal name, Social Security number/tax identification number, percentage, date of birth and relationship for each individual you designate as a beneficiary of your PESP account. If you use percentages to allocate (Please print) the distribution of your vested PESP account balance, the total percentage for each of your Primary or Secondary Continued Beneficiary designations must equal 100. Please list additional beneficiaries on a separate page, if needed. (I) Primary Beneficiary(ies) (II) Secondary Beneficiary(ies) Your Spouse s Consent and Signature (not applicable to Beneficiaries or Alternate Payees under QDROs) Total must equal 100. Total must equal 100. Your spouse must complete this section if you elected Option B on the previous page of this form. I am the spouse of the Participant, and have read the attached Instructions and PESP Rules for Beneficiary Designations including the section regarding the spousal death benefit provided under PESP. I understand the terms of the spousal death benefit to which I am entitled under PESP. I realize that if I consent to my spouse s PESP beneficiary designation as indicated on the previous page of this form, I am waiving some or all of my rights to the spousal death benefit under PESP. I also understand that as a result of my spouse s PESP beneficiary designation as indicated on the previous page of this form, I am not the sole Primary Beneficiary to my spouse s vested PESP account and that some or all of my spouse s vested PESP account balance will be paid to beneficiary(ies) other than myself in accordance with my spouse s beneficiary designation as indicated on the previous page of this form. I hereby voluntarily consent to my spouse s designation of such beneficiary(ies) and understand that by consenting, I am waiving my rights to some or all of the spousal death benefit under PESP. I agree to release and discharge the PESP trustee, Plan Administrator, and Prudential (and all their employees and agents) from liability for acting pursuant to this consent and realize that my consent is irrevocable. I understand that the beneficiary(ies) designations indicated on this form cannot subsequently be changed (except in a way that benefits me), unless I agree to the change by signing a new PESP Beneficiary Designation Form. X Date Spouse s signature - must be witnessed by a notary public. Notary Seal Subscribed and sworn before me on the day of, the year My notary commission expires with the state of Name and title of notary (please print) Signature of notary X I understand the information I have provided will be relied upon in processing my request. I further understand that I will Your be responsible for its accuracy in the event any dispute arises with respect to this request. I have read the attached Authorization Instructions and PESP Rules for Beneficiary Designations and authorize and direct Prudential to process this PESP Beneficiary Designation Form in accordance with my instructions as indicated on this form. I understand the PESP beneficiary designation that I have indicated on this form supersedes any previous PESP beneficiary designation and to the extent permissible under applicable law, will remain in effect until I change my beneficiary designation in accordance with the terms of PESP. Signature X Date PLAN Social Security Number - -

5 Trust Certification Form Instructions This form must be completed when you designate a trust as the beneficiary of some or all of your PESP account. About You Plan number Social Security number Daytime telephone number area code First name MI Last name Trust I certify that the Trust, dated : Information (Name of Trust) (Trust Date) Is valid under the laws of the state of ; Is irrevocable or will become irrevocable upon my death; The Trust s Beneficiaries names (including Primary and Secondary Beneficiaries), Social Security numbers and dates of birth listed in the Trust document are as follows (please list additional beneficiaries on a separate page, if needed): Social Security number: : Social Security number: : Certification Ed. 1/2003 Social Security number: : The Trustee is (Trustee - cannot be account holder) Tax Identification number of Trustee The Successor Trustee is (Successor Trustee - cannot be account holder) Tax Identification number of Successor Trustee I hereby certify that the above information is complete and if, in the future, the above-mentioned trust is amended, I agree to promptly provide the PESP Administrative Committee or its delegate with amended Beneficiary Designation and Trust Certification Forms. Further, I agree to provide the trust document and any amendments to the PESP Administrative Committee or its delegate upon demand. Signature X Date