This form must be signed, notarized and filed with the Retirement System prior to your death to be effective.
Primary and contingent: The same person or persons cannot be designated as both primary and contingent beneficiaries.
Estate: If you name your estate as primary beneficiary, you may not name any contingent beneficiary.
Accidental death: You may not designate beneficiaries to receive accidental death benefits.
Attachments: Attachments to your beneficiary form are unacceptable.
New form: New beneficiary forms filed will supersede any previous designation.
Alterations: The use of correction fluid or other alterations on this form will render the designation invalid.
| Question | Answer |
|---|---|
| Form Name | Form RS 5127 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 61 |
| Avg. time to fill out | 11 min |
| Edition | 11/22 |
| Where to send | New York State and Local Retirement System, 110 State Street, Albany |
| Who signs | The member or pensioner, before a notary |
| Other names | RS 5127, RS5127, Form RS 5127, NYS RS 5127, Designation of Beneficiary with Contingent Beneficiaries |
| Official source | Form RS 5127 (Rev 11/22), New York State and Local Retirement System |
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