Form

Update Beneficiaries
A beneficiary is an individual who will receive the remaining funds in an account after all account owners have passed away. If we do not have beneficiaries listed, the money in the account will go to the estate.
***Before any changes can be made to the beneficiaries on your account, ALL primary and joint owners need to sign below or fill out an additional form listing the same beneficiaries. These changes will be effective for all savings and checking accounts associated with the account number listed below.
Full Name *

First Name Last Name
Account Number

Address *

Phone Number *
E-mail *
Attach a Copy of your Driver's License or State I.D. (Should be for the person whose name is at the top of this form) *
Person that should be listed as beneficiary on my share accounts: *

First Name Last Name
Birth Date of Beneficiary: *

- Month - Day Year
Phone Number of Beneficiary *
Social Security Number of Beneficiary
(Helps us to identify your beneficiary)

Address of Added Beneficiary

Do you have additional beneficiaries you want listed on your share accounts? (This will split the money evenly between all named beneficiaries.) *

Yes No

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Additional person that should be listed as beneficiary on my share accounts: *

First Name Last Name
Birth Date of Beneficiary: *

- Month - Day Year
Phone Number of Beneficiary *
Social Security Number of Beneficiary
(Helps us to identify your beneficiary)

Address of Added Beneficiary

Beneficiary Stopper
Do you have a Share Certificate that you are wanting a beneficiary on? *

Yes No

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Please provide a description of the Share Certificate *
Person that should be listed as beneficiary on my Share Certificate *

First Name Last Name
Birth Date of Beneficiary: *

- Month - Day Year
Phone Number of Beneficiary *
Social Security Number of Beneficiary
(Helps us to identify your beneficiary)

Address of Added Beneficiary

Do you have an additional Share Certificate that you would like to list a beneficiary on? *

Yes No
Please provide a description of the Share Certificate *
Person that should be listed as beneficiary on my Share Certificate *

First Name Last Name
Birth Date of Beneficiary: *

- Month - Day Year
Phone Number of Beneficiary *
Social Security Number of Beneficiary
(Helps us to identify your beneficiary)

Do you have an additional Share Certificate that you would like to list a beneficiary on? *

Yes No
Please provide a description of the Share Certificate *
Person that should be listed as beneficiary on my Share Certificate *

First Name Last Name
Birth Date of Beneficiary: *

- Month - Day Year
Phone Number of Beneficiary *
Social Security Number of Beneficiary

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The beneficiaries listed on this form are the ONLY beneficiaries that will be listed on my savings and checking accounts from this point on until I fill out this form again. *

I understand
All beneficiaries listed on the 100 Regular Share will be the same as all other sub shares and checking accounts, unless otherwise stated. If you wish to name different beneficiaries on each account, you must contact us directly at 309-451-8400 *

I understand
Is there a joint owner on this account? *

Yes No
Is the joint owner present and able to sign this form to acknowledge the named beneficiaries above?

Yes No, I understand they will also have to fill out this form before the changes have been made.
Name of Joint Owner *

First Name Last Name
Attach a Copy of your Driver's License or State I.D. (Should be for the person who is joint on the account) *
Signature of Primary Account Owner *
Signature of Joint Owner *
Additional Comments:
Today's Date

- Month - Day Year
Should be Empty: