PAYABLE ON DEATH DESIGNATION - Key Direct

1 PAYABLE ON DEATH DESIGNATION Section One ACCOUNT TITLE DATE PRODUCT ACCOUNT NUMBER BANK NUMBER BRANCH NUMBER BRANCH REPRESENTATIVE Section Two I/We wish to designate the following beneficiary (ies) to my/our account: beneficiary (1)* beneficiary (2)* beneficiary Name beneficiary Soc.

2 Sec beneficiary Date of Birth beneficiary Home Address beneficiary Home Telephone No. beneficiary Business Telephone No. beneficiary Place of Work Section Three POD Agreement KeyBank National Association ( Bank ) is authorized to pay the funds in my/our Account at my/our DEATH (s) to the then surviving beneficiary (ies) named above, in EQUAL SHARES. Bank will not pay the funds to beneficiaries other than equal shares. If none of the beneficiaries survive me/us, the Bank shall pay the funds in my/our Account to my/our estate. I/We reserve the right, during my/our lifetime, to designate a change in beneficiary by executing and delivering to the Bank written notice of such change on a form prescribed by the Bank, such change of beneficiary (ies) to take effect as of the date of my/our execution of such written notice of change, whether I/we be living at the time of delivery of such written notice to the Bank or not, but without prejudice to the Bank on account of any payment made by it before receipt of such written notice.

3 I/We hereby designate the above-mentioned person(s) as the beneficiary (ies) of such Account and hereby revoke any DESIGNATION of beneficiary (ies) of such Account heretofore made. Signature of Account Owner 1 Signature of Account Owner 2 Date Section Four (for POD revocation only) I/ We revoke the PAYABLE on DEATH DESIGNATION . Signature of Account Owner 1 Signature of Account Owner 2 Date Section Five State of ss. County of The foregoing instrument was acknowledged before me this Day of 20 My Commission expires Notary Public FORM NO.

4 46-0126 REV 2/99 * Any percentage entered here will not be recognized by bank.