Designation of Beneficiary for                                                      PBGC Form 707 

             Benefits Owed at Death
             (Currently Receiving Pension Benefits) 
Pension Benefit Guaranty Corporation.   
P.O. Box 151750, Alexandria, Virginia 22315-1750                             For assistance, call 1-800-400-7242 
   Plan Name: FX.PrismCase.CaseTitle.XF 
   Plan Number: FX.PrismCase.CaseIdNmbr.XF        Participant Name: FX.PrismCust.FullName.XF 
   Date Printed: 04/10/2024 
   Date of Plan Termination: FX.PrismCase.DOPT.XF 

INSTRUCTIONS:  Use  this  form  to  name  or  change  your  beneficiary(ies)  for  payments  owed  at  death.  If  you  have  any 
questions, please call our Customer Contact Center at 1-800-400-7242.  Please print clearly with blue or black ink. 
1) If you are receiving a certain-and-continuous annuity, you may not use this form to change your beneficiary for the certain
period.  You may use PBGC Form 711.
2) If you are receiving  payments in a joint-and-survivor annuity, you may  not change your survivor annuity  beneficiary for
continuing payments

1. General information about you
   Last Name                                                                 First Name 
   Middle Name                                    Other Last Name(s) Used 

   Social Security Number 

             -              - 

   Mailing Address                                                     Apartment / Route Number 

   City                                                                State Zip Code 

   Country                                                             Email 

   Daytime Phone                                    Extension             Evening Phone 
   (               )                    -         x                       (                  )   - 

2. Signature – Sign  and date this document. Knowingly and willfully making false, fictitious or fraudulent statements
   to the Pension Benefit Guaranty Corporation is a crime punishable under Title 18, Section 1001, United States
   Code.

   I declare under penalty of perjury that all of the information I have provided on this form is true and correct. 

   SIGNATURE                                                                 DATE

                                                  CONTINUE ON BACK
                                                                          

                                                                                                Approved OMB 1212-0055 
                                                                                                   Expires 06/30/2027

Designation of Beneficiary for Benefits Owed at Death                                     Form 707, page 2 of 2 
(Currently Receiving Pension Benefits) 
Plan Number: FX.PrismCase.CaseIdNmbr.XF         Participant Name: FX.PrismCust.FullName.XF

3. Designation of Beneficiary for Payments Owed at Death – PBGC may owe you money at the time of your death.
Typically, this happens if your final benefit is higher than the estimated benefit we had been paying.  If another person continues to
receive your benefit after your death (as with a joint-and-survivor or certain-and-continuous annuity),          PBGC will pay any money
owed to that person.  If there are no continuing benefits or the person designated to receive continuing benefits dies before you, PBGC
will pay any money owed you at the time of your death to the person(s) and/or entity(ies) (such as a trust, church, estate or other
organization) that you designate in this section.  If you do not make a designation, or if all the beneficiaries you designate below die
before you, PBGC will pay the money in this order to: your spouse, your children, your parents, your estate, or your next of kin.

I name the following as my beneficiary(ies).  This designation replaces any previous designation and will only be effective when PBGC 
receives it. 

                     Beneficiary(ies)*          Social Security Number** Date of Birth**                        Relationship Percentage*** 

Name  _______________________________________ 

Address ______________________________________ 
_____________________________________________ 

Daytime Tel. No:_______________________________ 

Name  _______________________________________ 

Address ______________________________________ 
_____________________________________________ 

Daytime Tel. No:_______________________________ 

Name  _______________________________________ 

Address ______________________________________ 
_____________________________________________ 

Daytime Tel. No:_______________________________ 

*To name more beneficiaries, please list them with requested contact info, DOB and SSN on an attached sheet with your
signature.
**Complete if person.
*** Percentage(s) does not have to be provided.
The amount owed will be distributed equally among beneficiaries unless percentages are provided for each beneficiary and they total 100%.
If a beneficiary dies before you, the amount owed will be distributed equally among the remaining beneficiaries.

                                                                                                                Approved OMB 1212-0055 
                                                                                                                Expires 06/30/2027