Beneficiary Letter Sample Form – Fill Out and Use This PDF

Merrill Lynch

P.O. Box 1528

Pennington, NJ 08534 - 0689

Letter of Authorization - Action Required

Account Number: ____________________

This letter is regarding the distribution to the beneficiaries of _______________________________________

and may be used as my Letter of Authorization to make the appropriate distribution of the funds in the above referenced account (the “Account”). The following are the designated beneficiaries of the Account and the percentage of Account funds that each beneficiary is entitled to receive:

Beneficiary Name:	Beneficiary Percentage (%):
____________________________________	_______________
____________________________________	_______________
____________________________________	_______________

Please indicate how you would like to receive your distribution share (check one):

Mail check made payable to me for my portion of the Account as Beneficiary to the address indicated below (only available if Account funds are already in cash or invested in money market accounts)

Transfer to my Merrill Lynch account: # _______________________

Transfer to my bank or financial institution: * Bank/Financial Institution Name _____________

Account Number ________________________

*Broker Transfer Paperwork from the gaining bank is required and must be submitted with this request. Contact your financial institution and request Transfer Papers.

Merrill Lynch may liquidate a portion of the securities in the Account if there is not enough cash available to cover the cost of transferring the securities.

Register and Ship Securities in my name to the address below.

There is a $50.00 fee per security name; I authorize Merrill Lynch to deduct from my portion of the Account that amount necessary to register securities in my name. Merrill Lynch also may liquidate a portion of the securities in the Account if there is not enough cash available to cover the cost of registration of securities.

Please note this Account must be closed; we cannot remove or add any names to this Account. We cannot liquidate any assets inside of the Account. If you wish to open a new account to maintain the assets at Merrill Lynch you can do so by contacting the Merrill Lynch New Accounts department at

1-888-657-8278, Option 1 (please mark the appropriate box above for transferring funds into your new Merrill Lynch account and provide the new account number above).

Name: ___________________________________

Address: ______________________________________________

City/State/Zip: __________________________________

SS# / EIN#: _______________________________

Phone Number ______________________________

Signature of Beneficiary: _______________________________________

State of _________________ County of _______________________

The foregoing instrument was acknowledged before me this ________ day of _____________________,

______________________________ Beneficiary

______________________________ Notary Public
______________________________ My commission expires.	TODLOA-1009