Beneficiaries Black and White

Designation / Change of Beneficiary In the event of my death, I, the undersigned, a member of San Francisco Fire Credit Union, hereby designate: 1.

% share

Please print beneficiary name Address of beneficiary

City and State

2.

Zip Code % share

Please print beneficiary name Address of beneficiary

City and State

3.

Zip Code % share

Please print beneficiary name Address of beneficiary

City and State

4.

Zip Code % share

Please print beneficiary name Address of beneficiary

City and State

Zip Code

as my beneficiary(ies) to receive any and all amounts paid into my individual Credit Unions savings account(s), certificate account(s) and checking account(s). Multiple beneficiaries with no share percentage indicated will be deemed to share equally.

Member Name

Member Account #

Member Signature

Date