- NET-11.4 (3/06)
NEW YORK STATE TEACHERS’ RETIREMENT SYSTEM
10 Corporate Woods Drive, Albany, NY 12211-2395
DESIGNATI ON OF BENE FICI ARY
Last Name
First Name
M.I.
- Social Security Number
Street
EmplID
City, State, Zip
Is this your permanent address? This form must be properly notarized.
- 2.
- Any number of primary and contingent beneficiaries may be named, but you must designate at least
one primary beneficiary.
- Additional forms can be acquired from your employer, the System or downloaded ...
TRS Beneficiary Form 
