Trsl Form 3 PDF Details

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QuestionAnswer
Form NameTrsl Form 3
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesIII, pdf result form 3 results, Louisiana, trsl forms

Form Preview Example

Teachers’ Retirement System of Louisiana

8401 United Plaza Blvd, Ste 300 • Baton Rouge, LA 70809-7017

PO Box 94123 • Baton Rouge, LA 70804-9123

Telephone: (225) 925-6446

www.trsl.org web.master@trsl.org

Beneficiary Designation

Form 3 (12/12)

01-3

Submit original form no fax copies accepted

Check here if multiple beneficiary forms submitted

Print in ink or type all entries except signatures. Incomplete or altered forms will be returned. The following beneficiary designation(s) will replace all previous choices. Designations of beneficiaries become effective when received in the office of the Teachers’ Retirement System of Louisiana (TRSL). Forms received by TRSL after the date of the member’s death shall be null and void.

Section 1 — Member information

Name: Last, first, MI, suffix (Jr., III, etc.)

Phone

()

Social Security number

Street / P.O. Box

City, state, zip

Email address

Section 2 — Beneficiary designation

This designation supersedes all prior designations. You must include ALL beneficiaries that you wish to designate. If percentages are not provided, any amounts payable will be divided equally among all beneficiaries. Primary and contingent beneficiaries must separately total 100%. The number of primary or contingent beneficiaries that you may name is not limited (attach an additional sheet if necessary). “Contingent” beneficiaries are eligible for payment only if all primary beneficiaries die before the member does.

PRIMARY beneficiary’s name

Last, First, M

Social Security

number

Gender

Birth date

mm/dd/yyyy

Relation

Percentage

must equal 100%

M F

______ /______ /__________

________ %

M F

______ /______ /__________

________ %

M F

______ /______ /__________

________ %

M F

______ /______ /__________

________ %

CONTINGENT beneficiary’s name

Last, First, M

Social Security

number

Gender

Birth date

mm/dd/yyyy

Relation

Percentage

must equal 100%

M F

______ /______ /__________

________ %

M F

______ /______ /__________

________ %

M F

______ /______ /__________

________ %

Section 3 — Member signature

I hereby request that my beneficiary(ies) be designated as above. I understand that the beneficiary(ies) designated on this form will receive my contributions to the retirement system, unless I have qualifying survivors (spouse, children) entitled to a monthly survivor’s benefit.

I hereby authorize TRSL to make payment to the beneficiary(ies) whom I have designated and agree, on behalf of myself and heirs and assigns, that payment and acceptance of any such refund to my designated beneficiary(ies), if any, or my estate shall discharge all obligations of TRSL on account of any creditable service rendered prior to payment of the refund and shall constitute a release of all accrued rights of every kind and nature against TRSL. I hereby direct that, should I survive the aforementioned beneficiary(ies), the amount that would otherwise have been payable to the beneficiary(ies) shall be paid to my estate or to such other beneficiary(ies) as I shall designate with TRSL in accordance with the rules and regulations prescribed by the Board of Trustees.

Before these undersigned witnesses, I have signed my name this __________ day of ___________________________________ , ______________.

Member’s signature (do not print or type)

Date signed (mm-dd-yyyy)

Maiden name or other names used for employment

Section 4 — Witness signatures (Must be witnessed by persons other than beneficiaries.)

Signature of witness (do not print or type)

Street / P.O. Box

City, state, zip

 

 

 

 

 

Signature of witness (do not print or type)

Street / P.O. Box

City, state, zip

 

 

How to Edit Trsl Form 3 Online for Free

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Step 1: Hit the "Get Form" button above on this page to open our PDF editor.

Step 2: With our handy PDF editing tool, you may accomplish more than merely complete blank fields. Edit away and make your documents appear perfect with custom text added, or fine-tune the file's original content to excellence - all that accompanied by the capability to add just about any photos and sign it off.

Filling out this PDF needs thoroughness. Make sure all mandatory areas are completed correctly.

1. Start completing your Designations with a group of necessary blank fields. Gather all of the important information and be sure nothing is overlooked!

Stage # 1 for completing trsl

2. Soon after filling out this part, go on to the next stage and complete the necessary particulars in all these fields - CONTINGENT benefi ciarys name, Last First M, Social Security, number, Gender, Birth date mmddyyyy, Relation, Percentage, must equal, Section Member signature, I hereby request that my benefi, and I hereby authorize TRSL to make.

must equal, Social Security, and Gender of trsl

3. Through this stage, review I hereby authorize TRSL to make, Before these undersigned witnesses, Members signature do not print or, Date signed mmddyyyy, Maiden name or other names used, Section Witness signatures Must, Street PO Box, City state zip, Signature of witness do not print, Street PO Box, and City state zip. Every one of these will need to be filled in with greatest attention to detail.

Part no. 3 for filling in trsl

People who use this PDF frequently make some mistakes while completing Before these undersigned witnesses in this part. Be sure to reread what you enter right here.

Step 3: Revise the information you have entered into the blanks and click on the "Done" button. After creating afree trial account here, you'll be able to download Designations or send it through email immediately. The document will also be easily accessible in your personal account menu with your each and every modification. We don't share the information you use when completing forms at FormsPal.