Designation fill in form 2025

1. Click ‘Get Form’ to open the designation fill in form in the editor.
2. Begin by filling out the Member Section. Enter your last name, first name, social security number, middle initial, birth date, street address, city, state, zip code, and telephone number. Ensure that all required fields marked with an asterisk (*) are completed.
3. Designate your primary beneficiaries by entering their last name, first name, relationship to you, date of birth, and address. If there are multiple beneficiaries, specify the percentage of benefits each will receive; ensure these total 100%.
4. If applicable, repeat the process for secondary beneficiaries using the same format as for primary beneficiaries.
5. Review the Insured Member Agreement and provide your signature along with the date. If you have a spouse and designated someone other than them as a beneficiary, ensure they complete the Community Property Consent section.
6. Finally, return the original beneficiary form to UFCW Local 1442 at the specified address.

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