UNIFORM SINGLE- OR MULTIPLE-PARTY ACCOUNT FORM PARTIES
(Name One or More Parties):

__________________________________ __________________________________

OWNERSHIP (Select One And Initial):

____
____
____

SINGLE-PARTY ACCOUNT
MULTIPLE-PARTY ACCOUNT
Parties own account in proportion to net contributions unless there is clear and
convincing evidence of a different intent.

RIGHTS AT DEATH (Select One And Initial):

____

____

SINGLE-PARTY ACCOUNT
At death of party, ownership passes as part of party's estate.
SINGLE-PARTY ACCOUNT WITH POD (PAY ON DEATH)

DESIGNATION
(Name One or More Beneficiaries):
__________________________________ __________________________________
At death of party ownership passes to POD beneficiaries and is not part of
party's estate.

____

MULTIPLE-PARTY ACCOUNT WITH RIGHT OF SURVIVORSHIP
At death of party, ownership passes to surviving parties.

____

MULTIPLE-PARTY ACCOUNT WITH RIGHT OF SURVIVORSHIP
AND POD (PAY ON DEATH) DESIGNATION
(Name One or More Beneficiaries):
__________________________________ __________________________________
At death of last surviving party, ownership passes to POD beneficiaries and is
not part of last surviving party's estate.

____

MULTIPLE-PARTY ACCOUNT WITHOUT RIGHT OF SURVIVORSHIP
At death of party, deceased party's ownership passes as part of deceased party's
estate.

AGENCY (POWER OF ATTORNEY) DESIGNATION (Optional)

Agents may make account transactions for parties but have no ownership or
rights at death unless named as POD beneficiaries.
(To Add Agency Designation To Account, Name One or More Agents):

__________________________________ __________________________________

(Select One and Initial):

____ AGENCY DESIGNATION SURVIVES DISABILITY OR INCAPACITY
OF PARTIES
____ AGENCY DESIGNATION TERMINATES ON DISABILITY OR
INCAPACITY OF PARTIES.