wells fargo beneficiary

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Designation of Beneficiary Instructions to Participant Complete this Designation of Beneficiary using black ink pen and return it to Wells Fargo at the address shown on the reverse side of this form.
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Authorized and Unauthorized use of Information for Plan Designation A-1 I hereby authorize the use of my name, SSN and a photograph of me to participate in the U.S. Employee Stock Purchase Plan (LPS1), sponsored, administered and administered by the United States Department of the Treasury (Treasury) and administered by the Corporation for National and Community Service (National Center for Employment Solutions, Inc..) I also authorize the use of my full Social Security number and my photograph for the purpose of this form and of identifying me as a participant as specified in the LPS1 Program Participant List and for the purpose of the Participant's receipt of this application. I hereby authorize my representative to furnish for me and me only, a single copy of this application. I acknowledge that in using this information, I am accepting the terms and conditions outlined in the "Terms & Conditions of Participation" section of the LPS1 Program Participant List (which is incorporated herein by reference). I hereby authorize the use of all or any part of this application, and any photograph I may have of me, as specified in the Participant List for any purpose of marketing the LPS1 Program or for any other purpose. B-1 I hereby authorize the use of my full social security number and all or any part of this application, and any photograph of me, for the purposes of offering my services for the LPS1 program and for any other purpose or purposes permitted from time to time by the LPS1 Program Participant List. I further hereby authorize the use of all or any part of this application, and any photograph of me, for any purposes relating to the use, or offering for the purposes of the LPS1 program of any services, goods or facilities of any type, offered by the LPS1 Program or its subcontractors. I hereby also authorize the use of all or any part of this application and any photograph I may have of me, for the purpose of participating in any advertising or any other promotional activity of the National Center for Employment Opportunity (NCEO), the Corporation for National and Community Service, or the LPS1 Program or for any other purposes as permitted by the Participant List and/or the LPS1 Program Participant List. The U.S. Department of Labor, or its successor, shall administer the LPS1 Program pursuant to Title 5; Code of Federal Regulations, Title 5, Part 80; Subchapter III; Chapter 21; Subchapter J. Labor. All provisions of the LPS1
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