Zion Benefits Services, Inc.

Census Data & Beneficiary Designation Form

Screenshot 2023-09-09 153857

African Methodist Episcopal Zion Church

Zion Beneftis Services

Census Data & Beneficiary Designation Form

Minister's (Employee) Information

Name
MM slash DD slash YYYY
Status
MM slash DD slash YYYY
MM slash DD slash YYYY
Address
BENEFICIARY DESIGNATION (attach additional sheets if necessary)

Primary Beneficiary 1

Name
Address
MM slash DD slash YYYY

Primary Beneficiary 2

Name
Address
MM slash DD slash YYYY

Secondary (Contingent) Beneficiary 1

Name
Address
MM slash DD slash YYYY

Secondary (Contingent) Beneficiary 2

Name
Address
MM slash DD slash YYYY

Emergency Contact

Name

Signature

MM slash DD slash YYYY
Mail: Zion Benefits Services, PO Box 217114, Charlotte, NC 28221 / Fax: 704.714.1552 or Scan and Email: zbsassist@amezhqtr.org

Zion Benefits Services, Inc.

Contact

Office

3225 West Sugar Creek Rd.
Charlotte, NC 28269

Mailing

Post Office Box 217114
Charlotte, NC 28221

Call

Office: (704) 714-1505
Fax: 704 714-1552

Email

zbsassist@amezion.org