Beneficiary Designation Form

Instructions
The Beneficiary Designation Form authorizes WELS Church Extension Fund (CEF) to pay the principal and accrued interest on one or more Certificates to 501(c)(3) tax-exempt organizations or individual beneficiaries when you die. This form is designed to be used for beneficiary designations with regard to existing Certificates as well as for new Certificates in conjunction with an Investment Application if you wish to designate more than one beneficiary under Section 3: Payment on Death of the Investment Application.
Section 1: Certificate Information
If you are completing this form in conjunction with an Investment Application to designate more than one beneficiary for the Certificate you are purchasing, please follow the instructions below:

• In Section 1 of this form, identify the Certificate that your beneficiary designation will apply to by typing Application in the first Certificate identification line.

• In Section 3 of the Investment Application check the box next to Designated Beneficiary and write See attached Beneficiary Designation Form on the line provided for the name of the tax-exempt organization or individual beneficiary.

• Complete the Investment Application.
A field marked with a red asterisk is required.
Primary owner name*
First Middle Last
Primary owner e-mail*
A confirmation e-mail will be sent to the e-mail provided.
Enter e-mail Confirm e-mail
I have a joint owner*
- Yes
- No
Joint owner name
First Middle Last
Joint owner e-mail
Enter e-mail Confirm e-mail
Certificate number(s)

This form will apply to any Certificates you identify in the list.
Certificate #1
Certificate #2
Certificate #3
Certificate #4
Certificate #5
Certificate #6
Certificate #7
Certificate #8
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Section 2: Beneficiaries
You must identify at least one primary beneficiary to receive the principal and interest on your Certificate at your death. In addition, you may designate one or more contingent beneficiaries to receive the principal and accrued interest on your Certificate, in the event that each primary beneficiary either predeceases you or no longer functions as a 501(c)(3) organization with a mission purpose consistent with your intended donation.

So long as at least one primary designated beneficiary is either alive or functioning as a 501(c)(3) organization consistent with your intended donation, the contingent beneficiaries will not receive any of the proceeds from your Certificate(s) at your death. Instead, the proceeds will be divided among the remaining primary beneficiaries on a pro rata basis according to their respective percentages set forth in this form.

If you have more than six beneficiaries, please contact WELS Church Extension Fund at [email protected] or 866-511-7793.
Primary Beneficiary #1
Type of beneficiary*
- Primary
- Contingent
- Per stirpes
Name*
First Middle Last
Address*
Address line 1 Address line 2 City State Zip code
Enter percentage of Certificate(s) proceeds.
?
Percentage*
Primary
Enter percentage of Certificate(s) proceeds.
?
Percentage*
Contingent
Both the Social Security and employer identification (EIN) numbers are nine digits. Include the dash in your entry of either number (e.g., SSN 000-00-0000 or EIN 00-0000000).
?
Social Security or EIN*
Date of birth*
MM slash DD slash YYYY
Relationship*
I have additional beneficiaries*
- Yes
- No
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Beneficiary #2
Review the instructions regarding multiple primary, contingent and per stirpes beneficiaries.
• For each beneficiary after the beneficiary identified as Primary Beneficiary #1, you must select whether the beneficiary is a primary, contingent or per stirpes beneficiary.

• Identify the percentage of the proceeds of your Certificate(s) that you want that beneficiary to receive. For example, if you identify three primary beneficiaries, you may want the first to receive 50% of the interest and principal of your Certificate(s), while each of the other primary beneficiaries will receive 25% of the proceeds at your death.

• For each type of beneficiary, the total percentages of Certificate Proceeds you identify must add up to 100%. For example if you have identified three primary beneficiaries and two contingent beneficiaries, the total percentages of the primary beneficiaries should add up to 100%. The total percentages of the contingent beneficiaries should also add up to 100%.

• Per stirpes specifies that each branch of the deceased person's family receives an equal share of the Certificate(s), regardless of how many people are in that branch. For example, A and B are children of the deceased Certificate owner and are listed as primary beneficiaries per stirpes. If B is also deceased leaving children C and D (the grandchildren of the original owner), then A would receive a full half share of the Certificate(s) and each of B's two children would receive one quarter of the Certificate(s). Essentially they are dividing B's half share equally.
Type of beneficiary*
- Primary
- Contingent
- Per stirpes
Name*
First Middle Last
Address*
Address line 1 Address line 2 City State Zip code
Enter percentage of Certificate(s) proceeds.
?
Percentage*
Primary
Enter percentage of Certificate(s) proceeds.
?
Percentage*
Contingent
Both the Social Security and employer identification (EIN) numbers are nine digits. Include the dash in your entry of either number (e.g., SSN 000-00-0000 or EIN 00-0000000).
?
Social Security or EIN*
Date of birth*
MM slash DD slash YYYY
Relationship*
I have additional beneficiaries*
- Yes
- No

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Beneficiary #3
Type of beneficiary*
- Primary
- Contingent
- Per stirpes
Name*
First Middle Last
Address*
Address line 1 Address line 2 City State Zip code
Enter percentage of Certificate(s) proceeds.
?
Percentage*
Primary
Enter percentage of Certificate(s) proceeds.
?
Percentage*
Contingent
Both the Social Security and employer identification (EIN) numbers are nine digits. Include the dash in your entry of either number (e.g., SSN 000-00-0000 or EIN 00-0000000).
?
Social Security or EIN*
Date of birth*
MM slash DD slash YYYY
Relationship*
I have additional beneficiaries*
- Yes
- No

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Beneficiary #4
Type of beneficiary*
- Primary
- Contingent
- Per stirpes
Name*
First Middle Last
Address*
Address line 1 Address line 2 City State Zip code
Enter percentage of Certificate(s) proceeds.
?
Percentage*
Primary
Enter percentage of Certificate(s) proceeds.
?
Percentage*
Contingent
Both the Social Security and employer identification (EIN) numbers are nine digits. Include the dash in your entry of either number (e.g., SSN 000-00-0000 or EIN 00-0000000).
?
Social Security or EIN*
Date of birth*
MM slash DD slash YYYY
Relationship*
I have additional beneficiaries*
- Yes
- No

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Beneficiary #5
Type of beneficiary*
- Primary
- Contingent
- Per stirpes
Name*
First Middle Last
Address*
Address line 1 Address line 2 City State Zip code
Enter percentage of Certificate(s) proceeds.
?
Percentage*
Primary
Enter percentage of Certificate(s) proceeds.
?
Percentage*
Contingent
Both the Social Security and employer identification (EIN) numbers are nine digits. Include the dash in your entry of either number (e.g., SSN 000-00-0000 or EIN 00-0000000).
?
Social Security or EIN*
Date of birth*
MM slash DD slash YYYY
Relationship*
I have additional beneficiaries*
- Yes
- No

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Beneficiary #6
Type of beneficiary*
- Primary
- Contingent
- Per stirpes
Name*
First Middle Last
Address*
Address line 1 Address line 2 City State Zip code
Enter percentage of Certificate(s) proceeds.
?
Percentage*
Primary
Enter percentage of Certificate(s) proceeds.
?
Percentage*
Contingent
Both the Social Security and employer identification (EIN) numbers are nine digits. Include the dash in your entry of either number (e.g., SSN 000-00-0000 or EIN 00-0000000).
?
Social Security or EIN*
Date of birth*
MM slash DD slash YYYY
Relationship*

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Total Percentage
For each type of beneficiary, the total percentages of Certificate proceeds you identify must add up to 100%. For example if you have identified three primary beneficiaries AND two contingent beneficiaries, the total percentages of the primary beneficiaries should add up to 100%. The total percentages of the contingent beneficiaries should also add up to 100%.
Primary beneficiary total
Primary total must be 100%
Contingent beneficiary total
Contingent total must be 100%

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Section 3: Authorization and Signature
By signing below, you authorize WELS Church Extension Fund (CEF) to pay the outstanding principal and accrued interest on the Certificate(s) identified in Section 1 to the beneficiaries identified in Section 2 at your death. If you have designated a 501(c)(3) tax-exempt organization as a beneficiary, you acknowledge that this designation is advisory only and that WELS CEF may refuse to honor your request. If at your death a tax-exempt organization that you identified in Section 2 no longer functions as a qualified 501(c)(3) organization with a mission purpose consistent with your intended donation, you authorize WELS CEF to designate another tax-exempt organization to receive your donation. You may change or revoke any beneficiary designation in Section 2 at any time. But a beneficiary designation and this Beneficiary Designation form shall be binding on your heirs, beneficiaries and legal representative. In addition, you represent either 1) that you are unmarried or 2) that your spouse has signed either this form as an owner, or the spousal consent in the next section.
Date*
MM slash DD slash YYYY
Primary owner's signature*
Use your mouse or touch pad to add your signature.
Joint owner's signature*
Use your mouse or touch pad to add your signature.
Spousal Consent
I am the spouse of the primary owner or joint owner identified in Section 1 of this form. I give to my spouse any interest I have in the Certificate(s) identified in Section 1 of this form. I agree to my spouse naming a beneficiary other than myself. I acknowledge that I have received a fair and reasonable disclosure of my spouse's property and financial obligations. I shall have no claim against WELS CEF or any beneficiary designated under this form for any payment made to the beneficiary.
Spousal consent signature*
- The Spousal Consent section does not pertain to me.
- I need to sign as the spouse of the primary owner.
- I need to sign as the spouse of the joint owner.
Date*
MM slash DD slash YYYY
Signature of spouse of primary owner*
Use your mouse or touch pad to add your signature.
Name of spouse of primary owner*
First Middle Last
Signature of spouse of joint owner*
Use your mouse or touch pad to add your signature.
Name of spouse of joint owner*
First Middle Last
Data Protection
Data Privacy & Permission*
I AGREE with the terms of the WELS Church Extension Fund Privacy Policy.
Data Privacy & Permission*
NOTE TO EU CITIZENS, RESIDENTS, TOURISTS, AND OTHER PERSONS TEMPORARILY IN THE EU:

By submitting this form you consent to any and all information you provide and submit via the site being sent to the United States of America. The United States has not sought nor received a finding of “adequacy” from the European Union under Article 45 of the GDPR. WELS relies on derogations for specific situations as set forth in Article 49 of the GDPR. You are also informed that the United States presently does not have an adequate level of personal data protection as determined by the European Commission’s adequacy decision on October 6, 2015 (case c-362/14) and articulated in the European Union’s General Data Protection Regulation and has not received a similar designation of adequacy by any other foreign data protection authority. You agree to the transfer of your data and personal data to the United States, however, to be used in accordance with WELS Privacy Policy.
I AGREE with the terms of the WELS Privacy Policy.

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Instructions

Section 1: Certificate Information

Section 2: Beneficiaries

Primary Beneficiary #1

Beneficiary #2

Beneficiary #3

Beneficiary #4

Beneficiary #5

Beneficiary #6

Total Percentage

Section 3: Authorization and Signature

Spousal Consent

Data Protection