Application For Trs Membership Form Page 2
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1
2Teachers
Application for TRS Membership
Retirement
System of
To Be Completed by Employee --
Georgia
continued
Secondary
1. ____________________________________
_______________
__________
_______________
Benefi ciary
Name of Benefi ciary
Date of Birth
Sex (M or F)
Relationship to Me
Designation*
____________________________________
_____________________
_______
_____________
Please designate the
Address
City
State
Zipcode
secondary benefi ciary(ies)
Soc. Sec. No. _____________________________ Percentage of available benefi ts to be paid ____________ %
to receive payment of your
accumulated contributions
and interest should you die in
2. ____________________________________
_______________
__________
_______________
active service. A secondary
Name of Benefi ciary
Date of Birth
Sex (M or F)
Relationship to Me
benefi ciary(ies) receives
payment of your accumulated
____________________________________
_____________________
_______
____________
contributions and interest or
Address
City
State
Zipcode
a monthly benefi t (if vested)
Soc. Sec. No. _____________________________ Percentage of available benefi ts to be paid ____________ %
in the event your primary
benefi ciary(ies) predeceases
you.
3. ____________________________________
_______________
__________
_______________
Be sure to designate the
Name of Benefi ciary
Date of Birth
Sex (M or F)
Relationship to Me
percentage to be paid to your
____________________________________
_____________________
_______
____________
benefi ciary(ies). The total
Address
City
State
Zipcode
percentage for secondary
benefi ciaries should equal
Soc. Sec. No. _____________________________ Percentage of available benefi ts to be paid ____________ %
100%.
If no percentage distribution
4. ____________________________________
_______________
__________
_______________
is indicated, your benefi ts will
Name of Benefi ciary
Date of Birth
Sex (M or F)
Relationship to Me
be divided equally among the
eligible benefi ciaries. If you
____________________________________
_____________________
_______
____________
do not name a benefi ciary,
Address
City
State
Zipcode
any available benefi ts will be
paid to your surviving spouse.
Soc. Sec. No. _____________________________ Percentage of available benefi ts to be paid ____________ %
If you do not have a surviving
spouse, benefi ts will be paid
to your estate.
Prior Teaching
From (MM/YY)
To (MM/YY)
Name of Educational Institution or State Agency Employing You
Experience or
______/______
______/______
___________________________________________________
State of GA
______/______
______/______
___________________________________________________
Employment
______/______
______/______
___________________________________________________
______/______
______/______
___________________________________________________
______/______
______/______
___________________________________________________
* If you wish to name more than 4 primary or secondary benefi ciaries, please attach a separate sheet of 8.5” x 11” paper listing the additional benefi ciaries
(i.e. #5, #6, etc.) along with the same information requested in the benefi ciary section of this form. You must sign and date all additional pages.
For more information about your TRS membership benefi ts, please visit our website at The TRS Member’s Guide is available under the
Publications section of the website or you can request a copy by calling (404) 352-6500 or (800) 352-0650.
page 2 of 2
Two Northside 75
Suite 100
Atlanta, GA 30318
(404) 352-6500
(800) 352-0650
fax (404) 352-4885
TRS-2A (0605)
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