Pbgc Form 706 - Beneficiary Application For Pension Benefits - 2006
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5Beneficiary Application
PBGC Form 706
Approved OMB 1212-0055
for Pension Benefits - OF
Expires 04/30/06
Pension Benefit Guaranty Corporation.
For assistance, call 1-800-400-7242
P.O. Box 151750 • Alexandria, VA 22315-1750
Plan Name:
Plan Number:
Participant Name / SSN:
Date Printed:
Applicant Name / SSN:
Date of Plan Termination:
INSTRUCTIONS: Please complete this form to request that PBGC begin payments to you as the beneficiary of a
deceased participant, or an alternate payee. Use dark ink and be sure to print clearly. If you have
questions, call our Customer Contact Center at 1-800-400-7242 for information.
1. General information about you
Last Name
First Name
Middle Name
Other Name(s) Used
Social Security Number
Date of Birth (proof required)
Gender
�
MALE
-
-
/
/
�
FEMALE
Mailing Address
Apartment / Route Number
City
State
Zip Code
Country
Email (optional)
Daytime Phone
Evening Phone
E
XTENSION
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)
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x
(
)
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/
When would you like your pension benefit payments to begin?
(This must be a future date.)
MONTH
YEAR
Name of the plan participant:
�
CONTINUE
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