IF YOU ARE A HYATT LEGAL MEMBER: PLEASE FILL OUT YOUR CLAIM NO.:
LAST 4 DIGITS OF EMPLOYEES SS#:
Husband’s Full Name:
Wife’s Full Name:
Full Name and Birth Date of each Child:
Residence Address (including County):
Name and Address of Guardian for Children:(The guardian is the person whom will care for children until they reach age 18 in the event you or your spouse are deceased before they reach age 18)
Name and Address of the Alternative Guardian:
Name and Address of Independent Executor:(The independent executor is the person whom will administer your estate, pay your bills, funeral expenses, collect monies owed to you)
Name and Address of Alternative Independent Executor:
Name and Address of Trustee:(The trustee is the person whom will handle your children’s funds until they reach the age you want them to receive their funds. Age 22 or 25. Pays for guardians expenses, college expenses, etc.)
Name and Address of Alternative Trustee:
How do you wish to dispose of your property: Example: All to wife and then to children.
Per Stirpes – If child dies, that child’s share will pass to deceased child’s children: Yes No
Per Capita – If child dies, that child’s share will pass to remaining living children: Yes No
*Would you like a living will of directive to physician? If yes, please indicate name, address, telephone number of the person whom will make your medical decisions for you. (these items may not be covered by any legal plan you may have):
Your name:
Your phone number:
Your email address:
Type in the verification code to submit: