Designation of Beneficiary

Customer Information

First Name
OK First Name is required
Middle Initial
OK Middle Initial is required
Last Name
OK Last Name is required
Social Security Number
OK Social Security Number is required
Date of Birth

OK Date of Birth is required
Email
OK Email is required
Cell/Home Phone
OK Cell/Home Phone is required
Work Phone
OK Work Phone is required
Street
OK Street is required
City
OK City is required
State
OK State is required
Zip
OK Zip is required

Account Information

Account Number
OK Account Number is required

Beneficiary Information

First Name
OK First Name is required
Middle Initial
OK Middle Initial is required
Last Name
OK Last Name is required
Social Security Number
OK Social Security Number is required
Date of Birth

OK Date of Birth is required
Phone Number
OK Phone Number is required
Street
OK Street is required
City
OK City is required
State
OK State is required
Zip
OK Zip is required
Relationship
OK Relationship is required

Additional Comments
Optional OK Additional Comments is required

Security Code

OK is required

By clicking submit below, I instruct Washington Savings Bank to add the above beneficiary to my account number listed. This request supersedes all prior requests and only one beneficiary can be designated per account in accordance with Massachusetts law. I am not depending on Washington Savings Bank for legal or estate planning advice. Other requirements may apply. I agree to be bound by the terms and conditions covered in the appropriate Disclosure Statement and Cardholder Agreement.

Type your name here as your signature
OK Type your name here as your signature is required
Mother's Maiden name or Account Code
OK Mother's Maiden name or Account Code is required

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