Beneficiary Designation In ball-point pen, print the information below. L About You Name (last, first, mi) Social Security number Direct dial (area code/work number) - - ( ) - Work location (city, state) Payroll location Mail station/Room number Instructions Complete and sign Part I or Part II, NOT BOTH, to indicate your beneficiary for the following plans: Company Provided Life Insurance; Business Travel Accident and Seat Belt Insurance; L-3 Communications Savings Plan, L-3 Communications Pension Plan lump-sum death benefit (retirees only); as applicable, any prior plan benefits. If neither Part is signed, the Standard Beneficiary Designation is assumed, even if designations are listed in Part II. Part I By signing this Part I, I designate the Standard Beneficiary as indicated below for death benefits under all plans. Any benefit payable at my death will be paid to my - Standard Beneficiary spouse, if living at my death; Designation if my spouse is not living, surviving children equally, including legally adopted children; if no children survive, surviving parents equally; if neither parent survives, surviving brothers and sisters equally; if no brothers or sisters survive, estate. Authorization and The above designations cancel and supersede any and all previous beneficiary designations I have made with respect to all these plans and Signature will remain in effect unless I change them by written designation. Sign here Date Part II By signing and completing this Part II, I designate the following person(s) to receive, in the event of my death, the total amount of benefits available under the specific plan(s) below. Some examples of non-standard beneficiary designations are on the back of this form. The Standard Beneficiary Designation will be assumed for plans which have no beneficiary designated below. Non-Standard Name of Plan Beneficiary Designation: Beneficiary Designation Company-Provided Life Insurance Business Travel Accident and Seat Belt Insurance L-3 Communications Savings Plan L-3 Com Pension Plan lump-sum death benefit (retirees only) As applicable, any prior plan benefits Spouse’s Consent If you do not name your spouse as your sole primary beneficiary under the L-3 Communications SAVINGS PLAN, this form must be signed by for Non-Standard your spouse and notarized to validate that election. Beneficiary I, (print spouse’s name) _______________________________________________________________, recognize that my spouse has designated someone Designation other than me as the sole beneficiary to receive death benefits payable under the L-3 Communications Savings Plan. I understand that such designation means I will not be entitled to receive surviving spouse benefits otherwise required to be paid to me if my spouse should die before I do. I also understand that I have the right to limit my consent to my spouse’s designation to the individual(s) specified above. I hereby voluntarily relinquish that right and consent to the designation of someone other than me as my spouse’s sole beneficiary. Sign here Date Notarized Witness Signed and subscribed to before me this day of , 20 . to Spousal Waiver Notary’s Signature Notary’s Commission Expiration Date Authorization and The above designations cancel and supersede any and all previous beneficiary designations I have made with respect to all these plans and will remain in Signature effect unless I change them by written designation. Sign here Date Information Regarding Beneficiaries For your convenience, L-3 Communications uses the Standard Beneficiary Designation as shown in Part I for the coverage’s listed on the front of this form. This allows for an automatic update of your beneficiaries as your family composition changes. If no beneficiary designation is made, the Standard Beneficiary Designation is assumed. Separate and different beneficiaries may be designated for each plan by specifying the coverage for which each designation applies. However, if you do name different beneficiaries by plan but specific beneficiaries are not designated for each plan, the Standard Beneficiary Designation applies to any plans which have no beneficiary designated. You have the right to change beneficiaries at any time. However, your spouse must consent to any designation of primary beneficiary for the L-3 Communications Savings Plan if your spouse is not the sole primary beneficiary for that plan. To change beneficiaries complete a new Beneficiary Designation form. Other common beneficiary designations for employee death benefit coverage’s. If you do not want to use the Standard Beneficiary Designation, you may name anyone you like as your beneficiary, including any corporation except L-3 Communications. Below are some common alternate designations. Do not sign Part I, Standard Beneficiary Designation, if you intend to complete Part II. Beneficiary Examples of non-standard beneficiary designations; replace the Smith family names with your beneficiary’s name 1. One beneficiary Dorothy Smith, wife. 2. Two beneficiaries Peter Smith, father, and Joan Smith, mother, equally, or the survivor. 3. Three or more beneficiaries Peter Smith, father, Joan Smith, mother, Tom Smith, son, or the survivors, equally, or the survivor. 4. One beneficiary and one contingent beneficiary Dorothy Smith, wife, if living; otherwise, Tom Smith, son. 5. One beneficiary and two contingent beneficiaries Dorothy Smith, wife, if living; otherwise, Tom Smith, son, and Carol Smith, daughter, equally, or the survivor. 6. One beneficiary and three or more contingent Dorothy Smith, wife, if living; otherwise, Tom Smith, Carol Smith and Mary Smith, beneficiaries children, or the survivors, equally, or the survivor. 7. One beneficiary and provision for unnamed Dorothy Smith, wife, if living; otherwise, the children born of the marriage of the member and said children and their children wife who may be living and the surviving children of any such children who may be deceased. 8. One beneficiary and unnamed children Dorothy Smith, wife, if living; otherwise, the children born of the marriage of the member and said wife, or the survivors, equally, or the survivor. 9. Two beneficiaries and one contingent beneficiary Peter Smith, father, and Joan Smith, mother, equally, or the survivor; otherwise Dorothy Smith, wife. 10. Two beneficiaries in unequal portions Three-eight’s (3/8) to Peter Smith, father, and five eight’s (5/8) to Joan Smith, mother, if both survive; otherwise, all to survivor. 11. Trustee (Name and complete address) Trustee, under a trust agreement with the member; dated _____________________, or to the successor in said trust. 12. Common disaster Dorothy Smith, wife, if living on the tenth (10) day after my death; otherwise the children born of the marriage of the member and said wife, or the survivors, equally or the survivor. 13. Member’s estate Executor or Ddministrator of my estate. Note: If your beneficiary is a married woman, her given name must be used; for example: “Mary A. Doe” and not “Mrs. John C. Doe.” If your beneficiary is not related to you, use the term “no relation” and enter the beneficiary’s address. Under No. 1 through No. 10, you may choose to add “otherwise, the executor or administrator of the member.” Do not use No. 11 unless there is an executed Trust Agreement in existence. Under the laws of several states, your spouse may be entitled to a portion of the life insurance proceeds payable upon your death, regardless of any non- spouse beneficiary designation. If you designate a person other than your spouse as the beneficiary under your Company-Provided Life Insurance, consult with an attorney to determine what effect, if any, state law may have upon such designation.
Pages to are hidden for
"Beneficiary Designation L"Please download to view full document