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Beneficiary Designation Form

The document is a beneficiary designation form for an oil and gas advisory contract. It instructs the contractor to provide their name, address, contract number, and certificate number. It explains that primary beneficiaries will receive funds first, and contingent beneficiaries only if there are no surviving primary beneficiaries. Space is provided to list the names, addresses, ID numbers, relationships, dates of birth, and percentages for primary and contingent beneficiaries. The contractor must sign and date the form to authorize payment to the listed beneficiaries upon their death.

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Saqib Rodriguez
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484 views1 page

Beneficiary Designation Form

The document is a beneficiary designation form for an oil and gas advisory contract. It instructs the contractor to provide their name, address, contract number, and certificate number. It explains that primary beneficiaries will receive funds first, and contingent beneficiaries only if there are no surviving primary beneficiaries. Space is provided to list the names, addresses, ID numbers, relationships, dates of birth, and percentages for primary and contingent beneficiaries. The contractor must sign and date the form to authorize payment to the listed beneficiaries upon their death.

Uploaded by

Saqib Rodriguez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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AD Oil and Gas Advisory Limited

1 Princeton Mews, 167-169 London Road


Kingston Upon Thames, Surrey, KT2 6PT, UK
[email protected]
RC: 12207957

BENEFICIARY DESIGNATION FORM

Contractor's Name Contract Number

Contractor's Address Contract Certificate Number

WHO ARE YOUR BENEFICIARIES?

It is very important to clearly indicate your primary beneficiary(ies) and contingent beneficiary(ies). Contract
funds are paid to contingent beneficiary(ies) only if there is no surviving primary beneficiary(ies). If multiple
primary beneficiaries or contingent beneficiaries are named and no percentage distribution is noted, then any
funds payable to such beneficiaries will be split equally. If more space is needed to list your beneficiaries
please attach a sheet to this form. The beneficiary(ies) named on this form will be valid for this stated
contract payment only unless otherwise indicated by you. The beneficiary designation may not go into
effect until this form is signed and dated by you.

PRIMARY BENEFICIARY(IES)
Primary Beneficiary's Name and Address ID Relationship Date of Percentage: Must
Number to You Birth equal 100%
Name:
Address:
Name:
Address:
Name:
Address:

CONTINGENT BENEFICIARY(IES): Contingent beneficiaries will only receive benefit if there are no surviving primary beneficiaries.
Contingent Beneficiary's Name and Address ID Relationship Date of Percentage: Must
Number to You Birth equal 100%
Name:
Address:
Name:
Address:
Name:
Address:

I agree to allow AD OIL AND GAS ADVISORY LIMITED to release my payment for contract to the above stated
beneficiary.

Signature: ___________________________________________________________ Date: ____________________________________

AD OIL AND GAS ADVISORY LIMITED BENEFICIARY DESIGNATION FORM

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