Designation Of Beneficiary Form - New Jersey Division Of Pensions And Benefits 2009 Page 4
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4EB-0214-0809
INSTRUCTIONS FOR COMPLETING
THE DESIGNATION OF BENEFICIARY FORM
Designations of Beneficiary can now be submitted online when using the Member Benefit
Online System (MBOS). Online submission is quick and secure. Log on to MBOS or, if you are
a new user, register today at:
Dos and Don'ts of Beneficiary Designation
Do use proper names. Nicknames are not acceptable. When naming a married female as beneficiary, be certain
the proper name is given, e.g. Mary J. Jones, not Mrs. John R. Jones.
Do use specific names. The phrase "my children" or "my grandchildren" will not be accepted. You must list each
child using his or her specific name.
Do make a copy of your completed Designation of Beneficiary form before submitting it to the Division and
periodically review it to make sure all beneficiary information is correct. It is especially important to update this infor-
mation after a life event such as a birth, marriage, divorce, or death.
Don't use a Designation of Beneficiary form to update a beneficiary's address. A signed letter notifying us of
your beneficiary's address change will suffice. Your letter will be added to our files so your beneficiary information
remains current.
Do complete this form with an ink pen. Completing this form in pencil makes the form unacceptable.
Don't use "white out" or cross out names to make changes in designation. This makes the form unacceptable
and a new form will be mailed to you.
Don't name the same person or persons in both the “primary” and “contingent” beneficiary sections. This
makes the form unacceptable and a new form will be mailed to you.
Before submitting the Designation of Beneficiary form, be sure to complete the items indicated below. Failure to complete
this form totally and accurately may jeopardize the payment of your benefits. For any designation not naming a specific per-
son or a share and share alike distribution, please refer to Fact Sheet #68, Designating a Beneficiary .
Item 1: Indicate Your Pension System — Check the box of the pension system of which you are an active or retired mem-
ber (check one box only)
PERS - Public Employees' Retirement System
SPRS - State Police Retirement System
TPAF - Teachers' Pension and Annuity Fund
JRS - Judicial Retirement System
PFRS - Police and Firemen's Retirement System
POPF - Prison Officers Pension Fund
CPFPF - Consolidated Police and Firemen's Pension Fund
Item 2 through 4: Member Information — PRINT your full name, date of birth, Social Security number, and your pension
membership or retirement number.
Item 5: Nominate Your Group Life Insurance Beneficiary — PRINT the name of your primary beneficiary(ies) and con-
tingent beneficiary(ies). If this section is not completed, this benefit will automatically default to your estate.
Item 6: Nominate Your Pension Beneficiary — PRINT the name of your primary beneficiary(ies) and contingent benefi-
ciary(ies). If this section is not completed, this benefit will automatically default to your estate.
Item 7: All Members Must Complete the Following — Make sure to SIGN, DATE, and INDICATE YOUR ADDRESS and
DAYTIME TELEPHONE NUMBER on the form. On any additional sheets used to specify beneficiary information be sure
to include your signature and date on the sheet, and print your name, address, daytime telephone number and Social
Security number. Mail your completed form to:
Beneficiary Services
Division of Pensions and Benefits
PO Box 295
Trenton, NJ 08625-0295
If you have any questions on how to complete your Designation of Beneficiary form: Write to the Division of Pensions
and Benefits, PO Box 295, Trenton NJ 08625-0295, send an e-mail to pensions.nj@treas.state.nj.us or call the Division's
Office of Client Services at (609) 292-7524.
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