BENEFICIARY FORM - Deferred Compensation

1 Save time and paper! Update your BENEFICIARY online. Login at Social Security Number or Account Number _____If you want this BENEFICIARY designation to apply to ALL established Ohio DC accounts as of the signed date, provide your Social Security Number. If you want this BENEFICIARY designation to apply to only a specific Ohio DC account as of the signed date, provide the corresponding Account Number. Primary BENEFICIARY (ies) must total 100% and Contingent BENEFICIARY (ies), if applicable must also total 100%. Check one " BENEFICIARY Type" for each BENEFICIARY . Failure to do so may result in your designation being invalid. If percentages are not provided, your assets will be divided equally among your named primary beneficiaries orcontingent InformationBeneficiary Type (Check One): Primary ContingentName_____ SS# _____ _____ _____Relationship_____ Date of Birth_____ Percentage_____Beneficiary Type (Check One): Primary ContingentName_____ SS# _____ _____ _____Relationship_____ Date of Birth_____ Percentage_____Beneficiary Type (Check One): Primary ContingentName_____ SS# _____ _____ _____Relationship_____ Date of Birth_____ Percentage_____Beneficiary Type (Check One).

2 Primary ContingentName_____ SS# _____ _____ _____Relationship_____ Date of Birth_____ Percentage_____Beneficiary Type (Check One): Primary ContingentName_____ SS# _____ _____ _____Relationship_____ Date of Birth_____ Percentage_____I hereby designate the above BENEFICIARY (ies) to receive benefits payable under the Plan, if any, in the event of my _____Participant's Signature DateOHIO-0781-0620/WEBBENEFICIARY FORMREAD NEXT PAGE FOR INSTRUCTIONSBENEFICIARY form INSTRUCTIONS1. You may choose an individual, your estate, a trust, or charitable organization as your BENEFICIARY . Your contingent beneficiaries will only be paid if all of your primary beneficiaries are not living at the time of your death.

3 Check one " BENEFICIARY Type" for each BENEFICIARY . Failure to do so may result in your designation being invalid. Attach additional sheets, if You cannot name the same person as both primary and contingent All information on the BENEFICIARY form must be completed for processing. You must include the BENEFICIARY 's Social Security number or tax identification number, relationship, birth date, and percentage. Primary BENEFICIARY (ies) must total 100% and Contingent BENEFICIARY (ies), if applicable must also total 100%. BENEFICIARY Forms are legal documents. You must initial any changes made on the form . If percentages are not provided, your assets will be divided equally among your named beneficiaries or contingent beneficiaries.

4 4. If you are choosing a trust as your BENEFICIARY , Ohio DC must have a copy of the trust to process the If you are choosing a charity as your BENEFICIARY , Ohio DC must have the charity's taxpayer identification number to process the form . 6. If you choose your estate, trust, or charitable organization as your primary BENEFICIARY , there is no contingent BENEFICIARY . You may choose an individual as your primary BENEFICIARY and choose your estate, trust, or charity as your contingent BENEFICIARY in case the primary BENEFICIARY is not living at the time of your Beneficiaries who are minors (under the age of 18) will not receive a distribution unless a legal guardian is appointed. If this is the case, payments will be made to the guardian on behalf of the Be sure to sign and date the form before mailing.

5 Please keep a copy for your records. 9. The execution of this form and acceptance by Ohio DC revokes all prior designations that you have If you have any questions, please contact our Service Center at 877-644-6457 or visit Return form to: Ohio Deferred Compensation 257 East Town Street, Suite 457 Columbus, Ohio 43215-4626 Fax: 614-222-9457 OHIO-0781-0620/WEBOHIO DC