HomeMy WebLinkAboutOCDSB 736 Beneficiary Designation Change Form - Revised Jan 2016
BENEFICIARY DESIGNATION CHANGE FORM
PARTA–PERSONALINFORMATION
Employee Name EIN Province of Residence:
EmployeeElementarySecondary
ESPSSP(EA/ECE)PSSP PSSUUnion Exempt
Group: Teachers Teachers
Name of OCDSB Spouse (if applicable): EIN
PARTB–BENEFICIARYDESIGNATION(S)
PLEASE COMPLETE EACH SECTION FOR ALL BENEFICIARIES (QUOTES or DITTO’S ARE NOT VALID)
COVERAGE
NAME - LAST, FIRST, MIDDLE RELATIONSHIP TELEPHONE # DATE OF BIRTH PROCEED %
(must total
(under 18,
100%)
appoint Trustee)
BASIC ACCIDENTAL
DEATH AND
DISMEMBERMENT (AD/D)
RBC Policy # A808184
GROUP LIFE – BASIC
(GRLIFE)
Manulife Policy # 91650
GROUP LIFE –
VOLUNTARY
DIFFERENCE
(Former CBE Employees
Only)
OPTIONAL ACCIDENTAL
DEATH AND
DISMEMBERMENT (OAI)
RBC Policy # D808185
OPTIONAL TERM LIFE
INSURANCE (OTL)
Manulife Policy # 91650A
RETIREMENT GRATUITY
Grandfathered for employees who
qualified to receive it and who
were employed with the OCDSB
prior to 1 Sept. 2012.
PARTC–CHILDRENUNDERTHEAGEOFMAJORITY
Please complete this section if you have designated a beneficiary who is under the age of majority.
I appoint _________________________________ as Trustee to receive any amount due to any beneficiary under the age of majority (18). If the
plan member is a Quebec resident, it is assumed a Trust agreement has been drawn up.
PARTD–QUEBECRESIDENTSONLY
In Quebec, the designation of your spouse as beneficiary is irrevocable unless otherwise specified.I declare that my spouse is beneficiary, and the
designation is:
Revocable Irrevocable* (see below note)
*Note: If your beneficiary designation was previously marked ‘irrevocable’, his/her consent is required to change your designation in the future.
Include a signed and dated consent with this form. Please note that you are responsible for ensuring the validity of your designation.
PARTE–AUTHORIZATIONANDSIGNATURE
I hereby revoke any previous beneficiary designations in relation to my foregoing coverage(s) and designate the person(s) named above. I understand that if the above-
named beneficiary(s) predecease me and no other beneficiary has been appointed, the proceeds will be payable to my Estate. I understand that the beneficiary for
spousal and/or dependent children coverage shall be me, if living, otherwise the proceeds will be payable to my Estate. I reserve the right to change this designation at
any time, in the manner that is in accordance with the provision of any law or regulation. I will inform my beneficiaries that I have named them as a beneficiary and
that they have 31 days in the event of my death to initiate a life claim with the OCDSB Human Resources.
Employee’s Signature: Date:
Please return this completed form to the OCDSB – HR Operations, 133 Greenbank Road, Nepean, ON, K2H 6L3
Instructions for Completing the Beneficiary Designation Change form
To verify your current beneficiaries, please access employee inquiry at https://employeeservices.ocdsb.ca. After you
log in, select personal > benefits > click on radio button under column listing beneficiary and scroll down to see who
you have designated.
Complete the attached form making sure to provide all the details requested for the beneficiary (ies) and make
sure that the percentage of proceeds to be paid to the named beneficiary is indicated. All proceed amounts must
equal 100%.If no specific percentage is allocated among multiple beneficiaries then the proceeds would be
assumed to be shared equally. Please note that cohabitation of 12 months with same or opposite sex partner is
recognized as a common-law relationship.
You may name one or more beneficiaries, you may name your “Estate”, or you may list a charitable
organization by using a charitable organization name and number. You may wish to consult a lawyer prior to
naming your Estate in order to understand the implications of naming your Estate as beneficiary. You must
inform your beneficiaries that you have named them as a beneficiary and that they have 31 days in the event of
your death to initiate a life claim with the OCDSB Human Resources.
You may name the same individual(s) for all of your benefits or you may choose any combination of choices;
however, you must complete each section by specifically naming a beneficiary (ies) for each benefit. (No quotes
or ditto’s will be accepted)
You must sign, date and send the original document back to your HR Operations Administrator. For legal
reasons, copies, scans, faxes, etc. cannot be accepted.
Keep a copy of your designations for your records.
THINGS TO KEEP IN MIND
If you choose to designate a beneficiary who is a minor (i.e. under the age of 18) or who lacks legal capacity you
must appoint a trustee as noted on the attached form (see PART C, Children under the Age of Majority). If you
designate a trustee you may wish to consult with a legal advisor prior to completing the attached form.
If you live in the Province of Quebec you must also complete section D “Quebec Residents Only”
If you have any questions with regards to completing this form, please contact your HR Operations
Administrator. Any questions of a legal nature should be addressed to your lawyer.
SuperintendentHR Operations Administrator
Gamwell, Buffone, Giroux Franca Bruni franca.bruni@ocdsb.ca ext. 8339
Reynolds, Grigoriev Kathy Delorme kathy.delorme@ocdsb.ca ext. 8597
Macdonald, Baker Vacant c/o sharon.parr@ocdsb.ca ext. 8599
Towaij, McCoy Pam Lindsay pamela.lindsay@ocdsb.ca ext. 8330
Wiley Christopher Smithchristopher.smith@ocdsb.ca ext. 8376
Yorke-Slader, Carson Catherine White catherine.white@ocdsb.ca ext. 8423
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