Common use of Please Type or Print Clause in Contracts

Please Type or Print. Beneficial Owner’s First Name MI Beneficial Owner’s Last Name Co-Beneficial Owner’s First Name MI Co-Beneficial Owner’s Last Name Entity Name (if claimant is not an individual) Representative or Custodian Name (if different from Beneficial Owner(s) listed above) Address1 (street name and number) Address2 (apartment, unit, or box number) City State ZIP/Postal Code Foreign Country (only if not USA) Social Security Number Taxpayer Identification Number Telephone Number (home) Telephone Number (work) Email address Account Number (if filing for multiple accounts, file a separate Proof of Claim for each account) Claimant Account Type (check appropriate box): □ Individual (includes joint owner accounts) □ Pension Plan □ Trust □ Corporation □ Estate □ ▇▇▇/401K □ Other (please specify)