USAA Beneficiary Form

P.O. Box 659453
San Antonio, Texas 78265-9825
Designation of Benefi ciary
USAA Traditional, Roth, SEP and Simple IRAs
STEP 1: Complete the Designation of Benefi ciary form to change the benefi ciary information for your mutual fund or brokerage retirement
account.
STEP 2: Fax completed and signed form to 1-800-292-8177.
Account Information
USAA Number Social Security Number Marital Status
First Name MI Last Name
USAA Mutual Fund Account Number(s)
USAA Brokerage Account Number(s)
I revoke all prior designations made on the applicable IRA application and prior Designation of Benefi ciary form(s) regarding the
above accounts.
I understand this Designation of Benefi ciary will be effective on the date received by the Custodian (USAA Federal Savings Bank)
if I provide all the required information. I understand that upon any change of benefi ciary, the right of all previously-appointed
benefi ciaries to receive benefi t under this account no longer exists. I have the right to cancel this Designation of Benefi ciary and
to appoint a new benefi ciary at any time by writing to the Custodian.
Benefi ciary Information
NOTE: If you are married and live in a community property state and your spouse is not named as your sole primary benefi ciary,
you should consult your legal adviser about how your state’s community property law may affect the validity of your benefi ciary
designation.
A. Primary Benefi ciary
Check here if you are naming a trust as a benefi ciary. If naming a trust as benefi ciary; you are required to attach the fi rst
page; pages referencing retirement accounts; and the signature page of the trust agreement.
Primary Benefi ciary(ies) I hereby appoint and designate the following primary benefi ciary(ies) for my IRA: The IRA
shall be paid to the primary benefi ciary(ies) who survives you. If you appoint more than one primary benefi ciary, such primary
benefi ciaries who survive you shall share in your IRA equally, unless you state below a specifi c percentage of distribution to
each primary benefi ciary. If for any reason the percentages do not total 100%, any remaining assets shall be divided equally
among the surviving primary benefi ciaries.
Benefi ciary First Name (If trust, provide name of trust and trustee.) MI Last Name
Social Security Number (or Tax ID Number) Date of Birth (mm/dd/yyyy)
Relationship to IRA Account Owner % of Distribution
USAA 1-800-531-USAA (8722) Fax 1-800-292-8177 usaa.com
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34448-0609-W

Address City State Zip Code
First Name MI Last Name
Social Security Number (or Tax ID Number) Date of Birth (mm/dd/yyyy)
Relationship to IRA Account Owner % of Distribution
Address City State Zip Code
Attach an additional sheet of paper if more space is needed.
B. Secondary Benefi ciary
Check here if you are naming a trust as a benefi ciary. If naming a trust as benefi ciary; you are required to attach the fi rst
page; pages referencing retirement accounts; and the signature page of the trust agreement
Secondary (Contingent) Benefi ciary(ies) I hereby appoint and designate the following secondary benefi ciary(ies) for
my IRA: The IRA shall be paid to the secondary benefi ciary(ies) who survive you only if you survive the primary benefi ciary
(or all of the primary benefi ciaries, if you designate multiple primary benefi ciaries). In that event, surviving secondary
benefi ciary(ies) shall share in the IRA assets equally, unless you state below a specifi c percentage of distribution to each
secondary benefi ciary. If for any reason the percentages do not total 100%, any remaining assets shall be divided equally
among the surviving secondary benefi ciaries.
Benefi ciary First Name (If trust, provide name of trust and trustee.) MI Last Name
Social Security Number (or Tax ID Number) Date of Birth (mm/dd/yyyy)
Relationship to IRA Account Owner % of Distribution
Address City State Zip Code
First Name MI Last Name
Social Security Number (or Tax ID Number) Date of Birth (mm/dd/yyyy)
Relationship to IRA Account Owner % of Distribution
Address City State Zip Code
Attach an additional sheet of paper if more space is needed.
Signature
x
Signature of Account Holder Date (mm/dd/yyyy)
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