INSTRUCTIONS FOR COMPLETING NOTICE OF DEATH: Non-Spouse Beneficiary

These instructions supplement the Notice of Death Form. Each section of the form must be completed. DEFINITIONS Inherited IRA:

Rolling into an inherited IRA is the only rollover option available to a non-spouse beneficiary. An inherited IRA differs from a traditional IRA in that the deceased is still the owner. For this reason, the account balance must be fully distributed to the beneficiary within 5 years of the participant’s death or distributions from the IRA based upon life expectancy must begin by December 31st of the Year (see definition) following the Year the participant passed away.

Minimum Distribution:

This distribution is required by law to ensure that retirement benefits are used for their intended purpose - to provide a source of retirement income to participants or their beneficiaries. Distributions to beneficiaries must begin by the Required Beginning Date (see definition) and may impact the benefit option elected. A Minimum Distribution is also required if a beneficiary elects to rollover the distribution prior to the close of the Year (see definition) following the Year in which the deceased passed away even if the Required Beginning Date is in the future. Failure to take the required Minimum Distribution may result in a 50% excise tax on the amount that should have been distributed.

5% Owner:

A person will be treated as a 5% owner if he owned over 5% of company stock or business interest in the company sponsoring this retirement plan at any time during the Plan Year (see definition), in which he attained age 70½, or is a spouse, parent, grandparent, or child of a 5% Owner. Note: The deceased is not considered a 5% Owner unless the ownership exceeds 5%. For example, a person who owned exactly 5% of the company would not be considered a 5% Owner while someone who owned 5.1% would be.

5 Year Rule:

This rule requires that a beneficiary must take a full distribution no later than December 31st of the fifth Year (see definition) following the participant’s death.

Plan Administrator:

The administrator is designated by the company/union, for which the deceased worked, as the person who manages the Plan. He or she will be the person the beneficiary contacts with questions about this Plan’s specific provisions.

Required Beginning Date (RBD): (See Section C for Determining the RBD)

For a 5% Owner (see definition) the RBD is April 1st of the Year (see definition) following the Year in which the deceased participant became or would have become 70½. For non-5% Owners the RBD is the later of April 1 of the Year following the deceased participant’s separation from service or April 1st of the Year following the Year in which the deceased participant became or would have become 70½.

Year: In this industry, a year is always the calendar year covering the period January 1st – December 31st.

SECTION A (Deceased Participant Information) 1. Enter the deceased participant’s name, social security number, date of death and address on the appropriate lines. 2. Check “Yes” or “No” depending on whether or not the deceased participant was a 5% Owner (see definition) of

the company sponsoring this retirement plan. If you don’t know whether the participant was a 5% Owner, you must contact the Plan Administrator (see definition).

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SECTION B (Non-Spousal Beneficiary Information) Enter your name, social security number, date of birth, telephone number and/or email address and address on the appropriate lines. If the beneficiary is the Estate, enter the Estate Name, the Estate Executor’s Name, the Estate’s Taxpayer Identification Number (TIN), telephone number and/or email address of the Executor and the address of where the check is to be mailed. If the beneficiary is a minor (under age 18), enter the beneficiary name, guardian name, beneficiary social security number, date of birth, telephone number and/or email address and address on the appropriate lines. The guardian of the minor must provide court documentation showing proof of guardianship with the forms. If the guardian is the parent, proof of the parent relationship is required (i.e. birth certificate, adoption certificate or court order). Note: Your email address provides MassMutual with the quickest and most reliable means of contacting you should we require additional information to process your request. If you do not have one, you may provide us with a telephone number where we can reach you during normal business hours (Monday through Friday 8am to 8pm EST).

SECTION C (Election of Options) Note: Before making an election you may want to contact a tax advisor Determining the Required Beginning Date (RBD) – (see definition) The benefit options available to a beneficiary of a retirement account are determined by whether the deceased participant died before, or on or after the RBD for Minimum Distributions (see definition). IMPORTANT: Completing this section is critical to understanding the benefit options and how you may be impacted. To help you in selecting the appropriate benefit option, complete item one or two below (complete only one item).

Item 1 The deceased was a 5% Owner (see definition)

Did the Participant die prior to April 1st of the Year (see definition) following the Year in which the participant became 70½?

Select only one below If yes, participant died prior to Required Beginning Date (see definition)

If no, participant died on or after Required Beginning Date (see definition)

OR

Item 2 The deceased was Not a 5% Owner (see definition)

Did the Participant die prior to April 1st of the Year (see definition) after the later of:

1) The Year in which the participant turned age 70½? 2) The Year in which the participant separated from service?

Select only one below

If yes, participant died prior to Required Beginning Date (see definition)

If no, participant died on or after Required Beginning Date (see definition)

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Electing an Option IMPORTANT: If an Estate or Charity is the beneficiary, the benefit must be paid according to the 5 Year Rule (see definition). For this reason, the only options available are Continuation of Account and One-Sum Cash Payment. Continuation of the Account with MassMutual:

This election allows you to leave the account balance invested in the current plan. Generally, the account balance must exceed $5000 before you can select this option. In some cases this amount may be less but you would need to contact the Plan Administrator (see definition) to confirm this. If you elect this option, MassMutual will provide you with a Personal Identification Number (PIN), which will allow you to control the investment of the assets. If you are already a participant in this plan, your current PIN can be used to access this account. You may change the investment selections and / or request a distribution at any time, by contacting the Plan Administrator or MassMutual’s Participant Information Center. The money will be transferred to the beneficiary account, invested in the same investment selections in which the participant was invested in, unless you complete a Beneficiary/Alternate Payee Election Form to select alternate investments.

RBD Impacts: 1. If it was determined above that Death Occurred Prior to RBD (see definition), you can defer the

distribution of the death benefit but you must take a full distribution according to the 5 Year Rule (see definition). Additionally, if you intend to rollover the distribution to an Inherited IRA (see definition) at a later date, you must do so within the first 4 Years following the participant’s death. IMPORTANT: It is your responsibility to receive full distribution by December 31st of the fifth Year (see definition) of the participant’s death.

OR

2. If it was determined above that Death Occurred On /After RBD (see definition), you can defer distribution of the death benefit and receive Minimum Distributions (see definition) annually if the distributions you receive are paid at least as rapidly as the Minimum Distributions that were being paid to the participant. For this reason, if the participant was receiving installment payments, you must select either the Life Expectancy Installment Payments or the One-Sum Cash Payment option. The first Minimum Distribution will be paid to you at the time we process your Notice of Death Form unless the deceased participant already received a Minimum Distribution this Year (see definition). Please remember to complete the Income Tax Withholding Section of the form as your tax election will apply to the Minimum Distribution. IMPORTANT: It is your responsibility to request additional Minimum Distributions (see definition) annually by submitting a Required Minimum Distribution (RMD) Election Form. This form is available through the Plan Administrator (see definition).

Remember to attach a Beneficiary/Alternate Payee Election form to ensure that you assign a beneficiary and select investment options.

One-Sum Cash Payment To Me:

This election allows you to receive all or part of the benefit as a cash distribution payable to yourself. You can choose to have all of the assets or just a portion of them distributed to you. In either case, you must complete the Income Tax Withholding section of the form as your tax election will apply to the distribution. If you do not complete this section, MassMutual will withhold federal and any applicable state taxes.

RBD Impacts: 1. If it was determined above that Death Occurred prior to RBD (see definition), there are no restrictions

on your ability to elect this option.

OR

2. If it was determined above that Death Occurred on /after RBD (see definition), your distribution must at least cover the amount of the Minimum Distribution (see definition) if it is less than a full distribution. If you request an amount that is less, MassMutual will distribute the full amount required.

Remember to select an additional option for the remaining balance if you opt to have only a portion of your assets distributed to you.

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Direct Rollover: This election allows you to roll your distribution directly into an inherited IRA (see definition). If the account balance includes an after-tax balance (assets that can be withdrawn tax free), be sure to check in advance with the receiving institution to ensure that they accept rollovers of after-tax amounts. If they do not, a check will be issued payable to you for the after-tax balance.

IMPORTANT: This is not an option if the Estate is the beneficiary.

RBD Impacts:

1. If it was determined above that Death Occurred prior to RBD (see definition), there are no restrictions on your ability to elect this option.

OR

2. If it was determined above that Death Occurred on /after RBD (see definition), you must first receive

the Minimum Distribution (see definition) if any is required. MassMutual will distribute the Minimum Distribution payable to you and the remainder of the account balance will be rolled over per your instructions.

Remember to include the name of the financial institution on the form as the check will be issued payable to

them and mailed to you. Conversion to my Roth IRA:

This election allows you to convert your account balance to an established Roth IRA. Any assets that are taxable will be reported as such on a Form 1099-R and you will be responsible for paying taxes on those assets in the Year (see definition) they are distributed from the plan.

RBD Impacts:

1. If it was determined above that Death Occurred prior to RBD (see definition), there are no restrictions on your ability to elect this option.

OR

2. If it was determined above that Death Occurred on /after RBD (see definition), you must first receive

the Minimum Distribution (see definition) if any is required. MassMutual will distribute the Minimum Distribution payable to you and the remainder of the account balance will be rolled over per your instructions.

Remember to include the name of the financial institution on the form as the check will be issued payable to

them and mailed to you. Life Expectancy Installment Payments:

This election allows you to have the account balance paid to you in periodic installments for the remainder of your life. You must complete the Income Tax Withholding section of the form as your tax election will apply to all distributions. If you do not complete this section, MassMutual will withhold federal and any applicable state taxes. You can elect to have the payments made in monthly, quarterly, semi-annual or annual installments and they will be mailed directly to your home. You may change this election and request a full distribution at any time.

RBD Impacts:

1. If it was determined above that Death Occurred prior to RBD (see definition), you must commence payments no later than December 31st of the Year (see definition) following the Year the deceased passed away.

OR

2. If it was determined above that Death Occurred on /after RBD (see definition), there are no

restrictions on your ability to elect this option.

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Annuity: This election allows you to purchase an annuity from MassMutual. You must complete the Income Tax Withholding section of the form as your tax election will apply to all distributions. If you do not complete this section, MassMutual will withhold federal and any applicable state taxes. IMPORTANT: For more information about the annuity options available, contact the MassMutual Participant Information Center at 1-800-743-5274.

RBD Impacts:

1. If it was determined above that Death Occurred prior to RBD (see definition), you must commence payments no later than December 31st of the Year (see definition) following the Year the deceased passed away.

OR

2. If it was determined above that Death Occurred On/After RBD (see definition), you must first receive

the Minimum Distribution (see definition) for the year in which the participant died if the participant did not already receive this payment. If necessary, MassMutual will distribute the Minimum Distribution payable to you and the remainder of the account balance will be used to purchase an annuity per your instructions.

Remember to confirm that this option is available by calling 1-800-743-5274, then press 1 and #, #.

SECTION D (Income Tax Withholding) NOTE: Contact your tax advisor or the IRS if you have any questions concerning tax withholding. FEDERAL WITHHOLDING: As the beneficiary, you are entitled to elect a rollover distribution. If you roll over your entire distribution, no withholding will apply. If you receive all or any portion of your distribution in a form other than a rollover, then 20% withholding will apply to your distribution that is rollover eligible and 10% to your distribution that is ineligible for rollover. Federal income tax withholding is optional for any installment, annuity payment over life expectancy, or cash payments made payable to Estates or charities. Read the Special Tax Notice(s) that is included in this packet to determine if your distribution is rollover eligible and to determine if you want to directly rollover the distribution. STATE WITHHOLDING: Contact your tax advisor or your state’s tax department if you have any questions concerning state tax withholding. Refer to the State Tax Information document for important information regarding State Withholding in your Legal State of Residence. If you make an election that is not in compliance with your state’s regulations, MassMutual will default to your state’s requirements.

Remember to complete this section if instructed to under the benefit options section that you elected. If you fail to do so, MassMutual will automatically withhold federal taxes and any applicable state taxes as explained in this section.

SECTION E (Signatures) IMPORTANT: MassMutual is not able to process your benefit without the Plan Administrator’s signature as well as your own.

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Checklist --------------------------------------------------------------------------------------------------------------

1. Reminder: You may want to contact a tax advisor

2. Confirm that you have: Completed all Sections Signed the Form Obtained the Plan Administrator’s Signature All beneficiaries’ completed Notice of Death forms if you are not the sole beneficiary

3. Return the following

The Completed Notice of Death form or forms if not the sole beneficiary A Completed Beneficiary/ Alternate Payee Election form if you elected Continuation of

Account A Completed Direct Deposit Form( if applicable)

4. Forward your completed form(s) to the Plan Administrator of this Retirement Plan

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f6823 MassMutual Retirement Services, PO Box 219062, Kansas City MO 64121-9062 COMPLETE ALL PAGES For Overnight Mail: MassMutual Retirement Services, 430 W 7th St, Kansas City MO 64105

MassMutual Retirement Services (MMRS) is a division of Massachusetts Mutual Life Insurance Company (MassMutual) and affiliates.

NOTICE OF DEATH: Non-Spouse Beneficiary

All Asterisked (*) items are required to be completed in order to process the Benefit.

PLAN ADMINISTRATOR INSTRUCTIONS AND PLAN DATA IMPORTANT: MassMutual will process this death benefit upon receipt in good order.

• Ensure beneficiary is correctly identified before submitting this form. • Ensure this form is complete and that all asterisked items are completed. • Submit this form only after final contributions and loan repayments are submitted on the

deceased Participant's behalf and after you have received all designated beneficiary forms. Note: Final contributions/loan repayments invested after the benefit is paid are subject to this benefit election.

Account Number _______________ Sponsor Name _________________________________________________________________________________ Plan Name ____________________________________________________________________________________

A. DECEASED PARTICIPANT INFORMATION: Beneficiary or Plan Administrator must complete *Name ___________________________________________________________________________________________ first middle last *Was the Deceased Participant a 5% Owner of the above company? (See the Instructions for the definition of a 5%

Owner) Yes No *Social Security No. _______________________ *Date of Death (mm/dd/yyyy): __________________________

*Legal Address ___________________________________________________________________________________ street ___________________________________________________________________________________ city state zip

B. BENEFICIARY INFORMATION: Beneficiary must complete remaining sections, sign the form and obtain the Plan Administrator Signature

*Beneficiary Name/Estate __________________________________________________________________________ first middle last Executor/Guardian, if applicable _____________________________________________________________________ first middle last

* Telephone #

*Social Security No./TIN _____________ *Birth Date (mm/dd/yyyy)___________ E-mail Address __________________

*Address __________________________________________________________________________________ street __________________________________________________________________________________ city state zip Legal State of Residence _________________________________ If the Legal State of Residence is not provided, MassMutual will use the state provided in the Mailing Address for state tax purposes.

C. ELECTION OF OPTIONS For Participants’ account balances below the Plan’s minimum cashout amount (commonly $5,000; contact the Plan Administrator for details), only a One-Sum Cash Payment or Direct Rollover can be selected.

*CHOOSE ONLY ONE OF THE FOLLOWING OPTIONS:

Continuation of the Account with MassMutual: (Refer to the Instructions for important information

regarding this election and what your responsibilities are regarding future distributions.) Be sure to:

Attach Beneficiary/Alternate Payee Election Form (If this form is not received, or received and left blank, MassMutual will invest in the same manner as the deceased participant was invested)

Complete the Income Tax Withholding Section on page 2 if a minimum distribution is required (refer to the Instructions for important information regarding required minimum distributions)

f6823 MassMutual Retirement Services, PO Box 219062, Kansas City MO 64121-9062 COMPLETE ALL PAGES For Overnight Mail: MassMutual Retirement Services, 430 W 7th St, Kansas City MO 64105

MassMutual Retirement Services (MMRS) is a division of Massachusetts Mutual Life Insurance Company (MassMutual) and affiliates.

One-Sum Cash Payment to Me: All or Amount: $ __________ Unless “All” is selected, elect an additional option in this Section for the rest of your vested account balance prior to submitting this form. If you elect “One-Sum Cash Payment to Me” or “Amount” and do not indicate a dollar amount, the distribution will be processed for 100% cash payment.

Direct Rollover to an inherited IRA. Include After Tax (if applicable)?: Yes No Note: If no election is made, a check will be issued payable to you for the after tax amount. Name of financial institution to which the rollover check should be issued:

____________________________________________________________________________________________ Roth IRA Rollover Name of financial institution to which the rollover check should be issued: ____________________________________________________________________________________________

Conversion to my Roth IRA Name of financial institution to which the conversion check should be issued: ____________________________________________________________________________________

Life Expectancy Installment Payments: Periodic payments from my account to start the first day of: Enter Month _______________

Select Payment frequency: Monthly Quarterly Semi-Annually Annually.

Annuity: (Annuity options may not be available per the plan provisions. For more information about the annuity options available under the plan, contact the MassMutual Participant Information Center at 1-800-743-5274.)

Enter Annuity Starting Date: Month_____________ Day_____________ Year (see note below) _____________ Select Annuity: Immediate Deferred Select Annuity Type: Full Cash Refund Ten Year Stipulated Life Life with No Death Joint & Survivor – Full Joint & Survivor - 2/3 Joint & Survivor - 1/2

Note: Only complete the year if the participant died prior to the Required Beginning Date. The year designated cannot be later than the year in which the deceased participant would have attained age 70½. Refer to the Instructions for important information regarding the Required Beginning Date.

D. INCOME TAX WITHHOLDING *FEDERAL WITHHOLDING: Refer to the Instructions for important information regarding Federal Withholding

One-Sum Cash Payment or Direct Rollover: I read the Special Tax Notice(s) and (select only one option below): Withholding does not apply as this is a direct rollover of the entire taxable portion of my payment.

Deduct the 20% federal income tax withholding from the taxable portion of my payment. Deduct the 20% federal income tax withholding from the taxable portion of my payment and an additional amount of $_______________.

Installments or Annuity Payments Based on Life Expectancy: I read the Special Tax Notice(s) and I elect to have federal income tax: not withheld withheld.

If "withheld" is elected for installment or annuity payments, complete below (refer to IRS instructions for Form W-4P for more information):

a. Single Married Married, but withhold at the higher single rate b. Number of allowances __________________ c. I want the following additional amount withheld from each payment: $ _____________ *STATE WITHHOLDING: Refer to the Instructions for important information regarding State Withholding

No State Tax Withholding Election I have read the State Tax Information document and I elect to have no state income tax withheld from my

payment(s).

Voluntary State Income Tax Withholding I have read the State Tax Information document and I elect to have the following voluntary state income tax

withheld from my payment(s) (choose one): ____% $________ (whole dollar amount) ___ based on my state's tax table formula, if applicable (MassMutual will apply the default tax allowance)

Additional State Income Tax Withholding

I have read the State Tax Information document and I elect to have an additional ____% or $________ (whole dollar amount) state income tax withheld from my payment(s).

E. METHOD OF PAYMENT

Direct deposit to a bank account of which I am an account holder - Deposited within 3 business days from date of processing.

This option is NOT available for Rollovers.

To elect Direct Deposit, you must select either Checking or Savings and you must provide a voided check or copy of a pre-printed, account-specific deposit slip or a bank specification sheet from your bank for validation.

Checking Savings

___________________________________ __________________________________________ _______________________________________ Bank Name Bank ABA/Routing (9 digits) Bank Account No.

Please note that we can only send funds via direct deposit to banks with a valid U.S. routing number.

I understand that if I do not fully complete this section or the bank account information I have provided is invalid, a check will be mailed. I understand that a reprocessing fee may be charged to my account if the direct deposit is declined by my financial institution. Subsequent withdrawals will be processed in the same manner (up to 180 days from the date of the original distribution) unless I notify MassMutual in writing to distribute the money differently. I also authorize MassMutual to initiate a debit to my account for any overpayment or payments made in error.

Send payment by check - Allow up to 10 business days for postal service delivery.

F. SIGNATURES I understand that I have a right to a 30-day election period and I acknowledge that I am waiving the 30-day election period by making an affirmative election on this distribution form. I have read the Instructions and understand the elections I have made. I further understand there may be a charge for each distribution processed or a one-time installment or annuity set-up fee deducted from my account balance. If all required items are not completed on this form, payment will be delayed and the form may be returned to me for completion. If electing direct deposit, by signing below I certify that I am an account holder on the bank account listed above. *_______________________________________________ *_______/_______/_______ Beneficiary (Executor/Guardian, if applicable) Date Below to be completed by the Plan Administrator The Plan Administrator must determine that the individual submitting the claim is entitled to the participant’s benefit. MassMutual’s records of beneficiary designations may be incomplete or inaccurate and the Plan Administrator has the fiduciary responsibility to determine who is entitled to the benefit. I, the Plan Administrator, certify the above information is correct, the above beneficiary is the valid beneficiary as elected by the Participant or provided for by the Plan document, the beneficiary’s election is allowed under the plan, and all of the beneficiary’s election forms are included and completed in the request. *______________________________________________ *______/_______/________ Plan Administrator Date Please specify below if there is one beneficiary or multiple beneficiaries, along with the percentage of the participant’s benefit that the Beneficiary (specified above) is entitled to receive*: _____ The Beneficiary specified above is the sole Beneficiary entitled to 100% of the account _____ The Beneficiary specified above is one of multiple beneficiaries. Please indicate below the total number of beneficiaries

and the percentage of the participant’s benefit that the Beneficiary specified above is entitled to receive:

___________________________ ________________________________ Total Number of Beneficiaries Percentage this beneficiary is entitled to

Copyright ©2011 Massachusetts Mutual Life Insurance Company, Springfield, MA. All rights reserved. RS-30565-01 f6823 MassMutual Retirement Services, PO Box 219062, Kansas City MO 64121-9062 COMPLETE ALL PAGES For Overnight Mail: MassMutual Retirement Services, 430 W 7th St, Kansas City MO 64105

MassMutual Retirement Services (MMRS) is a division of Massachusetts Mutual Life Insurance Company (MassMutual) and affiliates.