Form Eb-0791-0812 - Designation Of Beneficiary - 2012

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State of New Jersey • Department of the Treasury
DIVISION OF PENSIONS & BENEFITS — BENEFICIARY SERVICES
P.O. Box 295, Trenton, NJ 08625-0295
DESIGNATION OF BENEFICIARY
Alternate Benefi t Program/Defi ned Contribution Retirement Program
ABOUT THE DESIGNATION OF BENEFICIARY FORM
THIS FORM WILL REPLACE ALL PRIOR DESIGNATIONS OF BENEFICIARY.
The Designation of Benefi ciary form allows a member of a New Jersey Alternate Benefi t Program (ABP) or
Defi ned Contribution Retirement Program (DCRP) to nominate a benefi ciary, or benefi ciaries, for benefi ts
payable upon the death of that member. This form applies to the group life insurance for active and retired
members of the ABP or DCRP.
GROUP LIFE INSURANCE
This designation is for any group life insurance benefi t payable at the time of your death. Group life insurance
does not apply to retirees with less than 10 years of service credit, or members who enrolled at age 60 or older
and failed to prove insurability.
For more information about your retirement contributions contact your investment carrier.
PRIMARY AND CONTINGENT BENEFICIARIES
Please be sure to designate both primary and contingent benefi ciaries. In the event of your death, the primary
benefi ciary (or benefi ciaries) will receive any death benefi ts that are payable. The contingent benefi ciary (or
benefi ciaries) will receive death benefi ts ONLY if all primary benefi ciaries have predeceased you.
Unless otherwise stated, all benefi ciaries will share and share alike. If no primary or contingent benefi ciaries
survive you, all death benefi ts will be paid to your estate.
You may nominate any of the following as your primary or contingent benefi ciary:
• A person or persons;
• An institution, charity, or corporation; or
• Your estate (upon your death a court ordered surrogate certifi cate will be required).
If you choose a distribution of benefi ts other than the standard “share and share alike,” or if you are
naming a minor, using a trust agreement, acting as a power of attorney for the member, or nominating
a civil union partner or domestic partner, please refer to Fact Sheet #68, Designating a Benefi ciary,
before
completing
this
form. You
may
obtain
this
fact
sheet
by
visiting
our
website
at:

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