Designation of Beneficiary with Contingent Beneficiaries (RS-5127)

What Is This Form For?

To add or update existing beneficiaries for your retirement payouts.

New NYS Employees' Retirement System members can designate a beneficiary to receive your ordinary death or post-retirement death benefit by completing this form.  Existing members can use this form to change beneficiaries on file.  If no beneficiary is selected, your death benefit will go to your estate.

Download the Form:

Is This Form Mandatory?


When to Submit

This form must be signed, notarized and filed with the retirement system prior to your death to be effective.

How to Complete This Form

Skip the paper by adding or updating your beneficiaries online using Retirement Online.

go to the Retirement Online website

If you send in a paper version of the form, it will need to be notarized.  You must send the New York State and Local Retirement System your original notarized form.  

Where to Submit This Form

Mail original notarized form to:

New York State and Local Retirement System

110 State Street

Albany NY, 12244-0001


Contact the BSC Benefits Team

Still have questions? Try the BSC Help Center where you can send a question to our support team or search a database of FAQs.

Contact us by phone:

Phone: 518-457-4272

Contact us by email:

Mailing Address:

Human Resources, BSC Records Management
Building 5, Floor 4
W. Averell Harriman State Office Campus
1220 Washington Ave
Albany, NY 12226-1900

Contact us by fax:

(518) 457-1879