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Tonganoxie USD #464
Basic Life and AD&D – Metlife:
This is a District paid benefit. Please list your beneficiary below.
Beneficiary Name
Relationship
Social
Security
Number
Date of
Birth
Primary or
Contingent
Percent (must
add up to 100%)
Trust or
Individual
Voluntary Life and AD&D – Metlife
:
Election Amount: Employee: $______________ Spouse: $ _________________ Child(ren): $_________________