Form Drs Ms 100 (Rev 2/13) - Member/retiree/participant Beneficiary Designation Form Page 3
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3INSTRUCTIONS AND GENERAL INFORMATION
Use this form to designate or change the person,
•
Please be aware that a beneficiary under the
estate, trust or organization to receive any money
age of 18 will not be allowed to make claim
due from your retirement and/or DCP account at
until reaching legal age. A claim cannot be
the time of your death.
made on behalf of a child without court-issued
Letters of Guardianship.
Please print in dark ink, make a copy of the
completed form for your records, and return it to
•
The one-time duty-related death benefit is
DRS. Do not use felt tip pens.
separate from your retirement benefit and is
available if you die as the result of injuries
Before you complete the form, please note:
sustained during employment or from an
occupational disease or infection that arose
•
This is one of the most important documents
naturally and proximately out of employment.
associated with your retirement account.
Judicial Retirement System members are not
Read and complete all sections carefully. If
eligible for this benefit.
you have any questions, please call us at
800-547-6657.
Signing the form:
•
Your retirement plan may have provisions
•
If your signature can only be made by mark,
that limit your beneficiary designation.
it must be witnessed by two individuals who
Check your handbook (available online at
sign in the area below your signature and
) for details.
initial next to the mark.
•
We will pay any benefits due after your death
•
An attorney-in-fact cannot sign for you unless
based upon the laws in effect on the date of
the Power of Attorney documents specifically
your death. A beneficiary designation may be
grant the power to designate a beneficiary.
invalidated in certain circumstances. See your
plan handbook for more information.
Submitting the form:
•
If you are receiving a survivorship benefit from
•
Your beneficiary designation is not valid until
someone else’s DRS retirement plan, call
it is fully complete, signed and received by
us to request a Beneficiary Designation for
DRS. Please submit it directly to DRS, not to
your employer.
Persons Receiving Survivor Benefits.
•
If you have money in more than one
•
If you are the Power of Attorney submitting
retirement system or program, and you
this form you will also need to send the
would like to designate different beneficiaries
following:
per plan; please complete a Beneficiary
1. A photocopy of the Power of Attorney
Designation form per plan/program.
document that grants you the power to
When filling out your beneficiary
designate a beneficiary.
designation(s):
2. Affidavit of Attorney-in-Fact completed
•
If you name a person, always show that
and notarized. You can access this form
individual’s legal given name. For example:
from our website at under
MARY K. DOE, not Mrs. Robert Doe.
forms.
•
If you designate a trust, your trustee will be
required to provide DRS with a full copy of the
trust document at the time of your death.
DRS MS 100 (R 2/13)
Page 3 of 3
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