Complete this form to nominate a beneficiary to distribute any amounts payable by PSERS in the event of your death.
Survival: in all cases, a nominated individual must survive you by 30 days.
Primary beneficiary: you must name at least one primary beneficiary.
Secondary beneficiary: for a secondary beneficiary to receive a benefit, all named primary beneficiaries must be deceased.
Changes: if you wish to change beneficiaries at a later date, you must submit a new designation with PSERS to revoke your prior designations.
Signature: your signature and the date you signed this form are required.
| Question | Answer |
|---|---|
| Form Name | PSRS-187 |
| Form Length | 9 pages |
| Fillable? | Yes |
| Fillable fields | 183 |
| Avg. time to fill out | 31 min |
| Edition | 07/2019 |
| Where to send | PSERS, 5 N 5th Street, Harrisburg PA 17101-1905 |
| Other names | PSRS-187, PSRS 187, PSRS187, Nomination of Beneficiaries, PSERS beneficiary nomination form |
| Official source | PSRS-187 (07/2019), Public School Employees' Retirement System |
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