Form Drs Ms 100 (Rev 8/10) - Member/retiree Beneficiary Designation Form Page 3
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3InstRUctIons anD geneRal InfoRMatIon foR
MeMbeR/RetIRee benefIcIaRy DesIgnatIon
Use this form to designate or change the person,
until reaching legal age. A claim cannot be
estate, trust or organization to receive any money
made on behalf of a child without court-issued
due from your retirement account at the time of
Letters of Guardianship.
your death.
•
The one-time duty-related death benefit is
Please print in dark ink, make a copy of the
separate from your retirement benefit and
completed form for your records, and return it to
is available if death occurs as the result of
DRS. Do not use felt tip pens.
injuries sustained during employment or an
occupational disease or infection that arose
before you complete the form, please note:
naturally and proximately out of employment.
Judicial Retirement System members are not
•
This is one of the most important documents
eligible for this benefit.
associated with your retirement account.
Read and complete all sections carefully. If
signing the form:
you have any questions, please call us at
1-800-547-6657.
•
Another person (other than your beneficiary)
must witness your signature on this document
•
Your retirement plan may have provisions
and complete the witness section.
that limit your beneficiary designation.
Check your handbook (available online at
•
If your signature can only be made by mark,
) for details.
it must be witnessed by two individuals who
sign in the witness section of the form and
•
We will pay any benefits due after your death
initial next to the mark.
based upon the laws in effect on the date of
your death. A beneficiary designation may be
•
An attorney-in-fact cannot sign for you unless
invalidated in certain circumstances. See your
the Power of Attorney documents specifically
plan handbook for more information.
grant the power to designate a beneficiary.
•
If you are receiving a survivorship benefit from
submitting the form:
someone else’s DRS retirement plan, call
•
Your beneficiary designation is not valid until
us to request a Beneficiary Designation for
it is fully complete, signed and received by
Persons Receiving Survivor Benefits.
DRS. Please submit it directly to DRS, not to
•
If you have money in more than one
your employer.
retirement system, you must complete a
•
If you are the Power of Attorney submitting
separate form for each system.
this form you will also need to send the
When filling out your beneficiary
following:
designation(s):
1. A photocopy of the Power of Attorney
•
If you name a person, always show that
document that grants you the power to
individual’s legal given name. For example:
designate a beneficiary.
MARY K. DOE, not Mrs. Robert Doe.
2. Affidavit of Attorney-in-Fact completed and
•
If you designate a trust, your trustee will be
notarized. You can access this form from
required to provide DRS with a full copy of the
our Web site at under
trust document at the time of your death.
forms.
•
Please be aware that a beneficiary under the
age of 18 will not be allowed to make claim
DRS MS 100 (R 8/10)
Page 3 of 3
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