Paul Hastings LLP Defined Contribution Retirement Plan (401k) Beneficiary Designation Form Print Name: Job Title: Social Security Number: (Optional) I understand that benefits are paid out in a lump sum. I hereby revoke any previous designation of beneficiary and make the following beneficiary designation with respect to monies due payable at my death under the Defined Contribution Retirement Plan (401k). (If you require more space, please copy this form, complete as needed, sign and date all copies and return to Benefits-Firmwide in Los Angeles). Please note: This beneficiary designation applies only to your Defined Contribution Retirement Plan. To change your beneficiary designation for any other amounts payable (i.e., life insurance, final pay, expense reimbursements and any other monies due you), use your online access to ebenefits. Beneficiary Designation (see attached instructions): Primary Full name(s): Share: Address: Social Security # (optional): Relationship: Birth Date: Full name(s): Share: Address: Social Security # (optional): Relationship: Birth Date:
Contingent Full name(s): Share: Address: Social Security # (optional): Relationship: Birth Date: IMPORTANT: If you are not naming your Spouse as the primary beneficiary of 100% of your Defined Contribution Retirement Plan, you must provide a Spouse s Consent to Beneficiary Designation form in order for your designation to be considered valid. If you do not meet this requirement, your current spouse will receive 100% of your Defined Contribution Retirement Plan account regardless of your designation. This requirement can be waived under certain circumstances, see below. Check a box: I have named my spouse as primary beneficiary for 100% of my Defined Contribution Retirement Plan account. I have attached my Spouse s Consent to Beneficiary Designation. I hereby request that the spouse s consent requirement be waived, and declare that: (Check one box below and complete information.) I have never been married. I am divorced. * My Spouse is deceased. * I cannot locate my Spouse. * * Provide your Spouse s name and (1) date of divorce; or (2) date of death; or (3) last known address and certification that you have made every effort to find this person by listing the actions taken: Signature: Date:
HOW TO USE THIS BENEFICIARY DESIGNATION FORM 1. Primary Beneficiaries are persons who need only survive you to receive benefits. You may name more than one Primary Beneficiary if you wish and you may designate different shares or amounts to go to the various Primary Beneficiaries. If you are naming more than one Beneficiary, state the percentage of your benefit that is to go to a particular Primary Beneficiary, rather than a fixed dollar amount (because the value of your account may fluctuate from day to day due to market conditions). The shares of all Primary Beneficiaries should total one hundred percent. Percents must be in whole numbers (ie: 33%, 33%, 34%, not 33.33%) in order to be valid. Example: a. If you want your entire interest to go to your spouse if he or she survives you, name your spouse as sole Primary Beneficiary and state that he or she is to receive one hundred percent. b. If there are two persons who are to share equally in your interest in the event of your death, name them each as Primary Beneficiaries, each to receive fifty percent. c. If there are two persons who are to receive benefits in the event of your death, and the share of one is to be a fixed dollar amount with the balance to go to the other, fill out one Primary Beneficiary blank for the Beneficiary who is to receive the fixed dollar amount and state such amount in the space designated "share." In the next Primary Beneficiary blank give the name of the Beneficiary who is to receive the balance, and in the space designated "share" write "residue of account after provision for " (giving the name of the other Primary Beneficiary). 2. If you name two Primary Beneficiaries and only one survives you and becomes entitled to benefits, that one will receive everything. If you name three Primary Beneficiaries, at 33%, 33% and 34% and only two survive you and become entitled to benefits those two will each receive one-half of your interest. If you need extra space, print additional Beneficiary Designation Forms and attach them to the first form and sign them. 3. If you wish to name someone other than your spouse as your sole Primary Beneficiary, your spouse must give his or her permission by completing a "Spouse's Consent to Beneficiary Designation." This consent form must be signed by your spouse and notarized. If, in the future, you have a different spouse, your new spouse will need to complete the Consent as explained above unless the new spouse is your sole Primary Beneficiary. If you are not currently married or if you are unable to locate your spouse, complete the Request for Waiver of Spouse s Consent. 4. You should name Contingent Beneficiaries to receive your interest in case all of your Primary Beneficiaries die before becoming entitled to benefits.
Examples: d. If you have a spouse and two children and you want your spouse to receive everything if he or she survives you, but if not, your children are to receive equal shares, name your spouse as Primary Beneficiary to receive one hundred percent and each child as a Contingent Beneficiary to receive fifty percent. If later you have more children, file a new Beneficiary Form if you wish such children to receive a share. e. If you have two daughters and one son, and you want your daughters to receive everything in equal shares if either or both of them survive you, and your son to receive everything if neither daughter survives you, you should name your two daughters each as Primary Beneficiaries to receive fifty percent and your son as Contingent Beneficiary to receive one hundred percent. 5. If you want all present and any future children living at your death to receive equal shares, fill out the "Name" blank in the Primary Beneficiary or Contingent Beneficiary Form, as the case may be, as follows: "All my lawful children, share and share alike." Spouse s consent will be necessary if you are married and name the children as primary beneficiaries. 6. Use each Beneficiary's legal name, e.g., "Helen Jones," not "Mrs. Henry A. Jones."
THE FOLLOWING FORMS ARE ONLY NEEDED WHEN DESIGNATING A NON-SPOUSE AS A PRIMARY BENEFICIARY FOR THE DEFINED CONTRIBUTION RETIREMENT PLAN
PAUL HASTINGS LLP (This form is needed only when designating a non-spouse as a primary beneficiary for the Defined Contribution Retirement Plan.) ( State of ) ( ) ss. ( County of ) SPOUSE'S CONSENT TO BENEFICIARY DESIGNATION, being duly sworn, deposes and says: (Name of Spouse) As the spouse of, I have read the Defined Contribution (Name of Participant) Retirement Plan Beneficiary Designation form attached to this affidavit and completed by my spouse. I understand that: 1. My spouse has named an entity or a person other than myself to receive benefits under the Firm s Defined Contribution Retirement Plan. This benefit may consist of community property in which I have an interest. 2. The designation of a beneficiary other than myself will cause some or all of any benefits payable on my spouse's death to be paid to the named beneficiary rather than to me. 3. If I do not voluntarily consent to my spouse's beneficiary designation, the designation will be invalid and I will receive the Defined Contribution Retirement Plan benefits that may be payable upon my spouse's death. I hereby voluntarily consent to and join in the beneficiary selections made by my spouse by means of the attached form. This affidavit of consent applies only to the attached form. As long as my spouse allows this form to remain in force, I hereby waive any and all claim to benefits that I may have under applicable law solely because of my status as the spouse of an employee. Prior to my
spouse's death, I retain the right to revoke this consent at any time by delivering a written revocation notice to Benefits-Firmwide. Upon my spouse's death, my consent shall become irrevocable. Subscribed and sworn to before me on. Date Signature of Spouse NOTARY SEAL Signature of Notary Public