I hereby acknowledge that under [Company Name]'s 401(k) plan, I am entitled to benefits at the time of my spouse's death. I understand that I would be entitled to the full amount of my spouse's benefit under the plan.
I understand that my spouse has designated the person indicated on the attached designation of beneficiary form as the primary beneficiary for the plan benefits or that my spouse has designated in addition to me an additional beneficiary(ies) (as designated on the attached designation of beneficiary form) as the primary beneficiary under the plan.
I understand that the effect of this designation is that I will not be entitled to benefits under the plan, or if my spouse has designated someone in addition to me as the primary beneficiary, that I will receive reduced benefits from the plan.
I am, hereby, specifically granting my consent to this designation.
I acknowledge that by signing this consent that I will not be entitled to benefits under the plan or will be entitled to reduced benefits.
I also understand that I may not revoke this consent.
Executed this _______ day of ___________________, 20_____.
Spouse's signature: ___________________________________
____________________
Plan Representative
___________________
Notary Public