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