Transfer on Death Beneficiary Designation Form

Transfer on Death Beneficiary
Designation Form
Use this form to add or update beneficiary records for a regular, taxable account registered
to an individual or to joint tenants with right of survivorship.
Return your completed form to:
Regular Mail
Overnight Mail
Fax
Homestead Funds
c/o BFDS
P.O. Box 219486
Kansas City, MO 64121-9486
Homestead Funds
c/o BFDS
330 W. 9th Street, 1st Floor
Kansas City, MO 64105-1514
Attn: Shareholder Services
703-907-5606.
If you have a question
about the form, call us
at 800.258.3030. For
complete information
about Homestead Funds
and services, see the
prospectus, which is available
at homesteadfunds.com
or by calling the above
toll-free number.
Be sure to sign
your completed
form (Section 3).
1.Ownership
Tell us how this account is registered.
Owner’s First NameMiddle InitialLast Name
Social Security Number
Daytime Telephone Number (in case we have questions)
–
–
If a Joint Account
Joint Owner’s First NameMiddle InitialLast Name
Social Security Number
Transfer on death instructions
cannot be established for IRA
accounts or for joint accounts
registered to tenants in
common or community
property or for UGMA/
UTMA, corporate, trust or
partnership accounts.
Joint Owner’s First NameMiddle InitialLast Name
Social Security Number
Daytime Telephone Number (in case we have questions)
–
–
Check one:
New Account:
Submit this form with your Individual or Joint Account Application.
Existing Account: Account Number
See a recent statement or trade confirmation for your account number, or call us.
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If we do not already
have this phone number
on file we will add it to
your contact information.
FRMTODDES 11/2014
Transfer on Death Beneficiary
Designation Form
2. Beneficiary Designation
Designate who should receive assets upon your death(s).
A. Primary Beneficiaries
NameRelationshipPercent
Date of Birth (mm/dd/yyyy)
/
/
%
If minor, name of parent/guardian
NameRelationshipPercent
Date of Birth (mm/dd/yyyy)
/
/
%
Your most current
beneficiary designations
replace any previous
instructions we have on file.
If minor, name of parent/guardian
NameRelationshipPercent
Date of Birth (mm/dd/yyyy)
/
/
%
If minor, name of parent/guardian
NameRelationshipPercent
Date of Birth (mm/dd/yyyy)
/
/
Upon your death,
beneficiaries listed on this
form will have claim to the
assets in the accounts you
list in Section 1 regardless of
any will, trust or any other
document you execute.
Assets are divided among
primary beneficiaries first.
If all primary beneficiaries
predecease the shareholder,
assets are divided among
secondary beneficiaries.
%
If minor, name of parent/guardian
(Percentages listed in Section 2A. Primary Beneficiaries must total 100%) Total
100
Attach a separate sheet if
you have more than four
beneficiaries, and provide all
of the information requested
here for each beneficiary.
%
B. Secondary Beneficiaries
NameRelationshipPercent
Date of Birth (mm/dd/yyyy)
/
/
%
If minor, name of parent/guardian
NameRelationshipPercent
Date of Birth (mm/dd/yyyy)
/
/
%
If minor, name of parent/guardian
NameRelationshipPercent
Date of Birth (mm/dd/yyyy)
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/
/
%
If you are married and
reside in a community
property state (Arizona,
California, Idaho, Louisiana,
Nevada, New Mexico, Texas,
Washington or Wisconsin),
you may need to obtain your
spouse’s consent if you have
not designated your spouse
as primary beneficiary for at
least half of your account.
See your lawyer or other tax
professional for additional
information and advice.
If minor, name of parent/guardian
FRMTODDES 11/2014
Transfer on Death Beneficiary
Designation Form
B. Secondary Beneficiaries (continued)
NameRelationshipPercent
Date of Birth (mm/dd/yyyy)
/
/
%
Please be aware that
confirmation statements
may not show all beneficiary
information due to system
formatting constraints.
If minor, name of parent/guardian
(Percentages listed in Section 2B. Secondary Beneficiaries must total 100%) Total
100
%
3.Signature
Each person named in the registration must sign below.
Owner’s SignatureDate (mm/dd/yyyy)
/
/
If a Joint Account
Joint Owner’s Signature Date (mm/dd/yyyy)
/
/
Joint Owner’s Signature Date (mm/dd/yyyy)
/
/
By signing this form you
are acknowledging that
you have read and agree to
the terms and conditions
of Transfer on Death
registration as outlined at
the end of this form.
Terms and Conditions of Transfer on Death Registration
Per your instruction, Boston Financial Data Services (BFDS), as transfer agent for Homestead Funds,
Inc. will register your account as a Transfer on Death (TOD) account. Per Massachusetts law, BFDS can
refuse to register accounts as TOD, or can adopt rules governing TOD registrations. BFDS is willing to
establish a TOD registration only upon the terms and conditions outlined below. If you do not agree to
these terms, please advise us of an acceptable alternative registration so that your account may be reregistered without a TOD designation.
Only simple beneficiary designations will be accepted for TOD directions. Complicated directions
should be accomplished through a will or trust drawn by the shareholder’s attorney.
By providing you with these rules, BFDS does not intend to give, and is not giving any advice as to
the legal effect of a TOD registration under applicable state laws governing inheritance and probate
procedures. Since TOD directions do effect the disposition of the account owner’s property at death, you
should consult with your attorney to make certain that the directions are consistent with your estate
planning and tax planning.
These rules are established by BFDS and may be cancelled, or amended, from time to time by us upon
prior written notice to you.
(1) A TOD registration may be designated by (i) a sole account owner or (ii) by two or more joint owners
only if the joint owners hold the account as joint tenants with rights of survivorship (and not tenants
in common). A custodian for a Uniform Transfers to Minors Act (UTMA) or Uniform Gifts to Minors
Act (UGMA) account may not designate a TOD on the registration.
(2) Account owner: The term “account owner,” as used herein, refers to either the sole owner of the
account or all joint owners of the account in the case of multiple owners. Actions to be taken by the
“account owner” must be taken by all joint owners in the case of multiple owners. Beneficiaries are
not “account owners” and have no rights in the account until the death of the last surviving
account owner.
(3) Designation of primary and contingent beneficiaries: An account owner may designate one, or
more than one, beneficiary of the TOD account. BFDS requires a Social Security Number for each
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Transfer on Death Beneficiary
Designation Form
designated beneficiary in order to ensure that the account is transferred to the appropriate person or
persons upon the death of the last surviving account owner.
An account owner may designate primary and contingent beneficiaries of the TOD account.
ɕɕPrimary beneficiaries are the first in line to receive the account upon the death of the last surviving
account owner if, and only if they survive all the owners.
ɕɕContingent beneficiaries receive the account upon the death of the account owner(s) if, and only if,
there are no surviving primary beneficiaries
An account owner is not required to designate any contingent beneficiaries in a TOD registration. See also Section 5 below for more information on rights of beneficiaries under your designation.
(4) Minors as beneficiaries: Minors may be beneficiaries of a TOD account only if a custodian, trustee, or
parent or guardian is set forth for the minor. The responsible adult named must be someone other
than the designating account owner.
By not providing a custodian, trustee, or guardian, the account owner is representing that all of the named beneficiaries have reached the age of majority and therefore are not minors.
(5) Rights of designated beneficiaries:
(a) Default arrangement is pro rata.
When an account owner instructs BFDS to register an account in TOD form and names multiple
beneficiaries, BFDS will treat the multiple beneficiaries as owning equal percentages as the
default arrangement.
(b) Optional percentage designations.
If an account owner wishes that the shares of his/her account be distributed unequally among
beneficiaries, the account owner must clearly state in writing a percentage for each beneficiary.
The total of all percentages must equal 100%. If the percentages do not equal 100%, or if the
instructions are unclear, BFDS will request further instructions from the account owner, and,
if necessary, will use the pro rata default stated above in Section 5(a) unless valid instructions
are received.
(c) Optional designations under Lineal Descendants Per Stirpes (LDPS).
If an account owner wishes to have the share of the account intended for a beneficiary to pass
to the children of the designated beneficiary in the event a designated beneficiary dies before
distribution from the account, the account owner must specifically instruct the Agent to register
the account as Lineal Descendants Per Stirpes or “LDPS.” If the abbreviation “LDPS” does not
appear on the TOD designation, the share intended for any designated beneficiary will not pass to
that deceased beneficiary’s children or descendants.
(d) Choice of LDPS designations applies to all beneficiaries on an account.
If a TOD account with multiple beneficiaries is registered LDPS, the LDPS registration will apply
to all beneficiaries designated, both primary and contingent. However, the shareowner also may
specifically designate a distinction between the treatment of primary beneficiaries as a class and
contingent beneficiaries as a separate class. E.g., all primary beneficiaries may be designated
as pro rata and all contingent beneficiaries designated as LDPS, or vice versa. It is not possible,
however, to mix the two types of designations within either class of beneficiaries.
(e) If a beneficiary dies and no LDPS designation is made. In the case of multiple beneficiaries, if one
of the beneficiaries does not survive the account owner and no LDPS designation is made, the
deceased beneficiary’s share of the account will be divided among the remaining beneficiaries
upon the death of the last surviving account owner.
(f) If all beneficiaries die before the last surviving account owner and no LDPS designation is made.
If no beneficiary survives the last surviving account owner and no “LDPS” designation has been
made, the account will be treated as part of the estate of the account owner.
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Transfer on Death Beneficiary
Designation Form
(6) Revocations of Changes: TOD registrations may not be made irrevocable. The account owner may
revoke or change a beneficiary designation. Change or revocation requires:
(a) A letter of instruction clearly indicating your wishes and providing required information for any
newly designated beneficiaries.
(b) In addition, for issued shares/certificates: presentation to BFDS of the security in proper form
for transfer.
(7) Controlling terms: The TOD beneficiary designation completed by the account owner expressly
provides that BFDS shall honor the account owner’s instructions.
As a result, the following terms will apply:
An account owner may change the TOD beneficiary or revoke the TOD registration at any time during
his life by a written instruction to BFDS.
The beneficiary or status of the account may also be changed by a court order directed to BFDS or
Homestead Funds.
The beneficiary or status of the account will not be automatically be changed by events subsequent to
the establishment of the account as a TOD (e.g. divorce).
The beneficiary or status of the account will not be automatically be changed by third party requests
based on state statutes.
Dividends, interest, capital gains, and other distributions after the account owner’s death:
(1) Accruals (undistributed earnings) of the account which occur after the death of the last
surviving account owner (or last surviving joint owner) stay with the account and pass to
the beneficiary or beneficiaries.
(2) Where the account has been coded for cash distributions, and such distributions have actually
been paid out prior to notice to BFDS of the death of the last surviving account owner, such
distributions are deemed to be the property of the estate of the original account owner and do not
pass with the account to the designated beneficiaries.
(8) Redemption or Transfer by a TOD beneficiary or beneficiaries: A single beneficiary on a TOD
registration must provide all of the following to redeem or transfer shares from a TOD account
following the death of the last surviving account owner: (i) a letter of instruction signed by the
beneficiary, Medallion Guaranteed, stating the name of the deceased account owner and the date
of the owner’s death; (ii) a completed new account application or change of registration form; (iii) a
Form W-9 or any successor form to Form W-9; and (iv) an inheritance tax waiver if required by the
deceased owner’s state of residence.
Foreign persons must also complete Form W-8BEN or any successor form to W-8BEN. In the case of
multiple beneficiaries, in addition to the requirements above, the beneficiary must also provide an
affidavit under penalty of perjury. Additional redemption or transfer requirements may be imposed.
Once again, be advised that the rules enumerated in this letter have been adopted by BFDS and
govern your TOD account.
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FRMTODDES 11/2014