Application For Trs Membership Form
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1
2Teachers
Application for TRS Membership
Retirement
System of
To Be Completed by Employee --
Georgia
please print clearly
Your Information
Please print or type all
Social Security Number
personal information.
Incomplete information
_____________________________________
___________________________
_______________
will delay the processing
Last Name
First Name
Middle Initial
of your membership.
___________________
__________
Marital Status (check one)
❑Single
❑Married ❑Widowed ❑Divorced
Date of Birth (mm/dd/yy)
Sex (M or F)
_____________________________________________________________________________________________
Street Address
__________________________________________
___________________
_______________________
City
State
Zipcode
_____________________________________________
___________________
____________________
Name of School System or State Agency Employing You
Title of Position
Date Employment Begins
Primary Benefi ciary
1. ____________________________________
_______________
__________
_______________
Name of Benefi ciary
Date of Birth
Sex (M or F)
Relationship to Me
Designation*
____________________________________
_____________________
_______
_____________
Please designate the
primary benefi ciary(ies) to
Address
City
State
Zipcode
receive payment of your
Soc. Sec. No. ____________________________ Percentage of available benefi ts to be paid ____________ %
accumulated contributions
and interest or a monthly
benefi t (if vested) should
2. ____________________________________
_______________
__________
_______________
you die in active service.
Name of Benefi ciary
Date of Birth
Sex (M or F)
Relationship to Me
Be sure to designate the
____________________________________
_____________________
_______
_____________
percentage to be paid to
Address
City
State
Zipcode
your benefi ciary(ies). The
total percentage for primary
Soc. Sec. No. ___________________________
Percentage of available benefi ts to be paid ____________ %
benefi ciaries should equal
100%.
3. ____________________________________
_______________
__________
_______________
If no percentage distribution
Name of Benefi ciary
Date of Birth
Sex (M or F)
Relationship to Me
is indicated, your benefi ts
will be divided equally
____________________________________
_____________________
_______
_____________
among the eligible
Address
City
State
Zipcode
benefi ciaries. If you do
Soc. Sec. No. ____________________________ Percentage of available benefi ts to be paid ____________ %
not name a benefi ciary,
any available benefi ts will
be paid to your surviving
4. ____________________________________
_______________
__________
_______________
spouse. If you do not have
Name of Benefi ciary
Date of Birth
Sex (M or F)
Relationship to Me
a surviving spouse, benefi ts
will be paid to your estate.
____________________________________
_____________________
_______
_____________
Address
City
State
Zipcode
Soc. Sec. No. ____________________________ Percentage of available benefi ts to be paid ____________ %
Your Signature
In order that I may be properly enrolled in the Teachers Retirement System of Georgia (TRS), I have carefully and
truthfully fi lled out this form. I understand that if I leave service without a retirement benefi t, I (or my benefi ciary(ies),
should I die in active service) may request that the full amount of my TRS deductions from my compensation, with
accumulated interest, be refunded to me.
______________________________________________________
___________________________
Signature
Date
To Be Completed by Employer
_________________________________________
__________________
__________________________
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Employer Signature (reviewed and signed by Employer)
Reporting Employer Number
Months in Employee’s Contract (check one)
*trs-2a*
page 1 of 2
TRS-2A (0605)
Two Northside 75
Suite 100
Atlanta, GA 30318
(404) 352-6500
(800) 352-0650
fax (404) 352-4885
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