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:
Use this form to add or update beneficiaries for retirement payouts.
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.
If you send in a paper version of the form, it will need to be notarized. You must send the BSC your original, signed form.
Where to Submit This Form
Mail original form to:
BSC Benefits Administration
W. Averell Harriman State Office Campus
1220 Washington Avenue
Building 5, Floor 4
Albany, NY 12226-1900
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.