Account Number : ____________________

Member FDIC

UNIFORM SINGLE-PARTY OR MULTIPLE-PARTY ACCOUNT

SELECTION FORM NOTICE

The type of account you select may determine how property passes on your death. Your will may not

control the disposition of funds held in some of the following accounts. You may choose to designate

one or more convenience signers on an account, even if the account is not a convenience account. A

designated convenience signer may make transactions on your behalf during your lifetime, but does

not own the account during your lifetime. The designated convenience signer owns the account on your

death only if the convenience signer is also designated as a P.O.D. payee or trust account beneficiary.

Select one of the following accounts by placing your initials next to the account selected.

Account

Selection

Account Type Description

(1) SINGLE-PARTY ACCOUNT WITHOUT “P.O.D.” (PAYABLE ON DEATH)

DESIGNATION. The party to the account owns the account. On the death of

the party, ownership of the account passes as a part of the party’s estate

under the party’s will or by intestacy.

Enter the name of the party:

_________________________________________________________________

Enter the name(s) of the convenience signer(s), if you want one or more

convenience signers on this account:

_________________________________________________________________

(2) SINGLE-PARTY ACCOUNT WITH P.O.D. (PAYABLE ON DEATH)

DESIGNATION. The party to the account owns the account. On the death of

the party, ownership of the account passes to the P.O.D. beneficiaries of the

account. The account is not a part of the party’s estate. Enter the name of

the party:

_________________________________________________________________

Enter the name or names of the P.O.D. beneficiaries:

_________________________________________________________________

Enter the name(s) of the convenience signer(s), if you want one or more

convenience signers on this account:

_________________________________________________________________

Date: Branch:

Employee:

Page 1 of 3 Rev. 8/2017

_________________________________________________________________

(3) MULTIPLE-PARTY ACCOUNT WITHOUT RIGHT OF SURVIVORSHIP. The

parties to the account own the account in proportion to the parties’ net

contributions to the account. The financial institution may pay any sum in

the account to a party at any time. On the death of a party, the party’s

ownership of the account passes as a part of the party’s estate under the

party’s will or by intestacy. Enter the names of the parties:

_________________________________________________________________

Enter the name(s) of the convenience signer(s), if you want one or more

convenience signers on this account:

_________________________________________________________________

(4) MULTIPLE-PARTY ACCOUNT WITH RIGHT OF SURVIVORSHIP. The

parties to the account own the account in proportion to the parties’ net

contributions to the account. The financial institution may pay any sum in

the account to a party at any time. On the death of a party, the party’s

ownership of the account passes to the surviving parties. Enter the names

of the parties:

_________________________________________________________________

Enter the name(s) of the convenience signer(s), if you want one or more

convenience signers on this account:

_________________________________________________________________

(5) MULTIPLE-PARTY ACCOUNT WITH RIGHT OF SURVIVORSHIP AND

P.O.D. (PAYABLE ON DEATH) DESIGNATION. The parties to the account

own the account in proportion to the parties’ net contributions to the

account. The financial institution may pay any sum in the account to a party

at any time. On the death of the last surviving party, the ownership of the

account passes to the P.O.D. beneficiaries. Enter the names of the parties:

_________________________________________________________________

Enter the name or names of the P.O.D. beneficiaries:

_________________________________________________________________

Enter the name(s) of the convenience signer(s), if you want one or more

convenience signers on this account:

_________________________________________________________________

Account

Selection

Account Type Description

Date: Branch:

Employee:

Page 2 of 3 Rev. 8/2017

Account Number : ____________________

_________________________________________________________________

Account

Selection

Account Type Description

(7) TRUST ACCOUNT. The parties named as trustees to the account own the

account in proportion to the parties’ net contributions to the account. A

trustee may withdraw funds from the account. A beneficiary may not

withdraw funds from the account before all trustees are deceased. On the

death of the last surviving trustee, the ownership of the account passes to

the beneficiary. The trust account is not part of a trustee’s estate and does

not pass under the trustee’s will or by intestacy, unless the trustee survives

all of the beneficiaries and all other trustees. Enter the name or names of

the trustees:

_________________________________________________________________

Enter the name or names of the beneficiaries:

_________________________________________________________________

Enter the name(s) of the convenience signer(s), if you want one or more

convenience signers on this account:

_________________________________________________________________

Date: Branch:

Employee:

Page 3 of 3 Rev. 8/2017

Account Number : ____________________

ACKNOWLEDGMENT: I acknowledge that I have read each paragraph of this form and have received

disclosure of the ownership rights to the accounts listed above. I have placed my initials next to the

type of account I want.

Customer Signature: Date