Plain-text representation of a screenshot of a confusing benefits-portal
form. In real use you'd hand the agent the actual screenshot; this is a
mockup so the exercise runs from the repo.

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   NORTHWIND BENEFITS PORTAL > Annual Enrollment > Step 4 of 7

   Beneficiary Election Reaffirmation Schedule (Q4-25 amendment)

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   Pursuant to Plan Amendment 2025-Q4-A (Sec. 3.2(b)(iv)), each
   Participant must reaffirm Primary and Contingent beneficiary
   designations across all qualifying instruments for which a
   Reaffirmation Trigger Event has occurred during the Reference
   Window. See the Plan Document, Article VII, for a list of
   Reaffirmation Trigger Events.

   Reference Window: 01 Oct 2024 — 30 Sep 2025

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   Instrument                            Status         Action

   [ ] 401(k) — Traditional             Affirmed       Reaffirm?
   [ ] 401(k) — Roth                    Pending        Reaffirm?
   [ ] HSA — Family                     N/A             —
   [ ] Group Term Life (1x salary)      Reaffirm req.   Reaffirm?
   [ ] Group Term Life (Suppl. 3x)      Reaffirm req.   Reaffirm?
   [ ] AD&D — Voluntary                 Affirmed       Reaffirm?
   [ ] Dep. Care FSA                    N/A             —

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   Election:

   ( ) I affirm my existing designations are current and accurate
       for all instruments above marked "Reaffirm req."
   ( ) I wish to update my designations (you will be routed to
       the Beneficiary Update Wizard before continuing)
   ( ) I decline to designate at this time (acknowledging that
       statutory default rules in Plan Sec. 7.4(c) will apply)

   [ ] I acknowledge that "Reaffirm req." items left unaddressed
       at the close of Open Enrollment will be treated under
       statutory default rules.

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