Beneficiary Designation Form - Calstrs Forms (Page 3 of 3) in pdf

BENEFICIARY DESIGNATION FORM

AUTHORIZATION

Subject to the spousal consent requirements, I understand that I may revoke or change this designation at any time by filing a new designation of

beneficiary in writing with the CalSTRS Pension2 and that by doing so, I revoke all prior designations.

I understand that if none of the above-named beneficiary(ies) survive me, all benefits under the Plan will be distributed according to the provisions

established by California law.

I hereby certify under the pains and penalties of perjury that the information I furnished herein is true, accurate and complete.

PARTICIPANT SIGNATURE ________________________________________________________________________ DATE ___________________________

CHECKLIST

PLEASE REVIEW YOUR APPLICATION CAREFULLY

If your application is complete, please mail or fax

the application and any additional documents to:

Read the required instructions.

VIA FAX

Voya Financial

rovided complete personal information including name, Social Security number,

Attn: CalSTRS Pension2 Plan Administration

and marital status.

1-888-814-5862

Provided your Primary Beneficiary(ies). Make sure you have completed all the

VIA MAIL

sections and that your percentages of benefit total 100%.

Voya Financial

Attn: CalSTRS Pension2 Plan Administration

Had the Spousal Consent section signed and notarized (with an official notary

P.O. Box 24747

stamp or seal) if you are married and do not name your spouse as your sole Primary

Jacksonville, FL 32241-4747

Beneficiary.

VIA OVERNIGHT DELIVERY

Voya Financial

Completed the Contingent Beneficiaries section (only if you want to have

Attn: CalSTRS Pension2 Plan Administration

contingent beneficiaries). The total percent equals 100% of benefit.

8900 Prominence Parkway

Jacksonville, FL 32256-8264

Listed the name, address, Social Security number, birth date and relationship of all

Beneficiaries.

Signed and dated your Beneficiary Designation (Authorized Signature).

Must be dated in the last 90 days.

Made a copy for your records and send the original to CalSTRS Pension2 Plan

Administration.

You will receive a confirmation statement on your beneficiary elections. If you have any

questions or need to obtain additional plan or account information, please go online at

or call the CalSTRS Pension2 Service Center at 1-844-elect2 (1-844-353-2872)

(TTY/TTD users call1-800-468-5449). Customer Service Associates are available Monday

through Friday, 6:00 A.M. to 5:00 P.M. Pacific Time (excluding stock market holidays).

BENEFICIARY DESIGNATION FORM / PAGE 3 of 3

CZ400CZ1BENEMAY

01/11/2016

Beneficiary Designation Form - Calstrs Forms Page 3

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