Beneficiary Form

United Nations Federal Credit Union
Court Square Place, 24-01 44th Road

Long Island City, NY 11101, USA
T: +1 347-686-6000 | F: +1 347-686-6400
[email protected] | www.unfcu.org
Beneficiary Form
Use this form to designate one or more beneficiaries for the account(s) listed below. You must be the primary or joint account holder on these accounts. Your
beneficiaries will receive the money in the listed accounts after your death. The legal term is a transfer on death. Please refer to the UNFCU Membership
and Accounts agreement for information on how the money will be distributed.
The beneficiary designation shall be governed by New York State law. It will also be subject to the terms outlined in the UNFCU Membership and Accounts
agreement. This Beneficiary Form will void and replace any previous beneficiary designations on the listed accounts.
If you want to designate more than four beneficiaries, attach the additional information. If you want to designate an organization as a beneficiary, see the
next page.
Send us your completed form by secure email. If you do not already have a secure email account, go to unfcu.org/email to request one. You can also drop
this off at one of our locations or mail it to the address on the top right.
_____________________________ _____________________________ _____________________________ _____________________________

First name Middle name Last name Member number
______________________ ______________________ ______________________ _______________________ _______________________

Account number(s) Account number(s) Account number(s) Account number(s) Account number(s)
1. Beneficiary Designation 2. Beneficiary Designation
___________________________________________________________ ___________________________________________________________
Beneficiary name (Last, First Middle) Beneficiary name (Last, First Middle)
____________________________________ ____________________ ____________________________________ ____________________

Relationship Birth date (DD Mon YYYY) Relationship Birth date (DD Mon YYYY)
____________________________________ ____________________ ____________________________________ ____________________

Address (Number and street) Apt. number Address (Number and street) Apt. number
___________________________ _____________ ______________ ___________________________ _____________ ______________

City, State / Province Zip / Postal code Country City, State / Province Zip / Postal code Country
3. Beneficiary Designation 4. Beneficiary Designation
___________________________________________________________ ___________________________________________________________
Beneficiary name (Last, First Middle) Beneficiary name (Last, First Middle)
____________________________________ ____________________ ____________________________________ ____________________

Relationship Birth date (DD Mon YYYY) Relationship Birth date (DD Mon YYYY)
____________________________________ ____________________ ____________________________________ ____________________

Address (Number and street) Apt. number Address (Number and street) Apt. number
___________________________ _____________ ______________ ___________________________ _____________ ______________

City, State / Province Zip / Postal Code Country City, State / Province Zip / Postal Code Country
UNFCU | serving the people who serve the world ® Page 1 of 2

Beneficiary Form
Complete this section if you wish to designate an organization as your beneficiary.
___________________________________________________________________________________________________________________________
Organization name
___________________________________________________________________________________________________________________________
Tax identification number (TIN) or ID number
___________________________________________________________________________________________________________________________
Address (Number and street)
_____________________________ _____________________________ _____________________________ _____________________________

City State / Province Zip / Postal code Country
Additional details:
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
x ________________________________________________________________________________ ________________________________________
Member signature Date (DD Mon YYYY)
OFFICE USE ONLY

___________________________ _____________________________ _____________________________ ___________________________
MSR name MSR signature Person number Date (DD Mon YYYY)
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United Nations Federal Credit Union

Court Square Place, 24-01 44th Road

_______________ _ _ _______________

__________ _ _____________

1. Beneficiary Designation 2. Beneficiary Designation

________________

________________

_____________________ _ _____________ _ ________

3. Beneficiary Designation 4. Beneficiary Designation

________________

________________

_____________________ _ _____________ _ ________

UNFCU | serving the people who serve the world ® Page 1 of 2

Complete this section if you wish to designate an organization as your beneficiary.

_______________ _ _ _______________

OFFICE USE ONLY

UNFCU | serving the people who serve the world ® Page 2 of 2

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