Please read the following instructions before you complete this form. Correct information regarding your

beneficiary(ies) will insure that in the event of your death, the amount in your account will be distributed in

accordance with your wishes. This beneficiary designation covers any balance you may have in the QSIP.

You may change you beneficiary designation at any time by completing a new form.

Complete this section to designate one or more primary beneficiaries, which may be an individual, your estate, a

trust, or a church, organization, charity or other type of institution. You must provide the full mailing address and

the EIN or tax identification number for a trust, estate, church, organization, charity or other type of institution.

unless you have submitted the QSIP Beneficiary Designation Form with Section C completed and notarized.

Complete this section to designate one or more contingent beneficiaries, which may be an individual, your estate, a

trust, or a church, organization, charity or other type of institution. You must provide the full mailing address and

the EIN or tax identification number for a trust, estate, church, organization, charity or other type of institution.

Complete this section if you are married and you designate a primary beneficiary other than or in addition to your

spouse (i.e.; multiple primary beneficiaries; a trust; your estate; a church, organization, charity, or other type of

institution). Your spouse must sign Section C of the form, as indicated, and a notary public must witness his /her

signature.

If you are single at the time you complete this form and then marry, your beneficiary designation will not be valid

while you are married. Benefits will be paid automatically to your surviving spouse unless you complete a new

beneficiary designation form naming another person with the Qwest Service Center. Your spouse much sign Section

C of the new form, as indicated, and a notary public must witness his /her signature.

If you are in the process of a divorce and your divorce is not final under applicable state laws, you should be aware

that the “notarized spousal consent�?is required to designate an alternate beneficiary until such time as the divorce is

final. If you divorce and the beneficiary form on file designates your ex-spouse as your primary beneficiary, you

must complete a new beneficiary designation form to remove your ex-spouse as your designated beneficiary.

If you have a “common law�?spouse and reside in a state where “common law marriage�?is recognized, you should

be aware that, in the event of your death, the law requires that benefits be paid to your “common law�?spouse if you

have not submitted a “notarized spousal consent�?designating an alternate beneficiary.

Be sure to sign and date the form, keeping a copy for your records. Return the completed form to the Qwest

Savings & Investment Plan, P.O. Box 57160, Jacksonville, FL 32241-7160.

If you have additional questions, please contact the Qwest Service Center at 1-800-729-PLAN (7526).

Please be advised that the Plan may not be able to make a distribution in accordance with your beneficiary

designation if all necessary information is not supplied to the Plan Administrator at the time the beneficiary

designated by your form makes a claim for payment.

1. A social security number, and

2. A current address.

1. A legal guardian or conservator to accept the distribution, along with a copy of court papers appointing the

legal guardian or conservator, or if none,

2. Proof that the person lives with the parent or other responsible adult; or, if none,

3. Custodian for the minor under the Uniform Gifts to Minors Act under applicable state law.

1. A copy of the trust document. The name of the trust must agree with the trust name that has been written on

your beneficiary designation form.

2. The federal tax identification number of the trust.

3. A current address for the trustee.

4. If your beneficiary designation names a trust “as established by my will�?(or contains similar language) the

administrator will require a copy of your valid last will and testament.

5. A trustee may be required to provide proof of his/her legal authority to that office. (This means that he/she

may have to produce the legal document that named him/her trustee.)

1. The name, address, and tax identification number, which you were required to put on our beneficiary

designation form, must be correct.

2. The name and current address of the administrator (or executor) of your estate will be required. The

taxpayer identification number of your estate will be required.

1. The name and current address of the administrator (or executor) of your estate.

2. The taxpayer identification number of your estate.

3. A copy of the court papers appointing the administrator (executor) of your estate.

Page 1 of 2

Beneficiary Information: Your beneficiary will receive any benefits payable from the Qwest Savings & Investment Plan

in the event of your death. You may change your beneficiary(ies) at any time. Please complete the following information

for your beneficiary(ies).

In the event of my death, I hereby designate as my primary beneficiary(ies)

If any primary beneficiary has predeceased me, that share shall be distributed prorata to the remaining beneficiaries, based on their

respective percentages.

In the event of my death, I hereby designate as my contingent beneficiary(ies) in the event all of my primary beneficiaries

have died before me:

If any contingent beneficiary has predeceased me, that share shall be distributed prorata to the remaining beneficiaries, based on their

respective interests.

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spouse (including children), as your primary beneficiary, you MUST have your spouse sign this form and have a notary

public witness the signature. If this is not done, your plan account will be paid automatically to your spouse at the time of

your death, as required by law.

I have read and consent to the above beneficiary designation. I understand that by consenting to this election I will not be

entitled to certain benefits that would otherwise be provided me by the Plan in the event of my spouse’s death. I

understand I am not required to consent to such election and I am doing so of my own volition. This consent is

irrevocable.

Spouse's Signature__________________________________ Date:_____________________

Notary Public______________________________________ Date:_____________________

Place Notary Stamp Here:

THE RIGHT TO CHANGE ANY OR ALL BENEFICIARIES AT ANY TIME IS RESERVED. ANY PRIOR DESIGNATION IS

HEREBY REVOKED.

I understand that any beneficiary designation made by me as an unmarried participant will be invalid during any later

period of marriage and that the benefits will be paid automatically to my surviving spouse unless I have obtained and file

with the Qwest Service Center a notarized spousal consent (Section C) designating an alternate beneficiary. I also

understand that any notarized spousal consent is valid only for the spouse who signs that consent. I also understand that if

I name my spouse and later divorce, my ex-spouse will remain as my beneficiary unless I complete a new form or

remarry.

Employee’s Signature _______________________________________ Date______________________________

Please return this completed form to:

QWEST Savings & Investment Plan

P. O. Box 57160

Jacksonville, FL 32241-7160