Application to change or add a beneficiary (beneficiaries)

(in a supplementary pension insurance contract including a state financial contribution)

Surname:

First name:

Title:

Address:

Postcode:

Telephone number:

Birth ID No.:

Number of contract:

I hereby replace the hitherto specified list of beneficiaries in my supplementary pension insurance contract with the following:

Surname, first name, title:

Birth ID No.

Proportion in %

If you name more than one beneficiary, the sum of their percentage proportions must equal 100%. If your contract is governed by Pension Plan No. 3, your signature must be verified by a notary or
accredited employees of ING Penzijní fond, a.s.

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ING Penzijní fond, a.s.,
Nádražní 344/25, 150 00 Prague 5, 5,
Company Registration No.: 63078074, registered at the Municipal Court in Prague, section B, file 3019