Form TRS15_Designation of Beneficiary

*+15*
TEACHER RETIREMENT SYSTEM OF TEXAS
1000 Red River Street, Austin, Texas 78701-2698
Telephone (512) 542-6400 or 1-800-223-8778
www.trs.state.tx.us
TRS 15
Rev. 01-12
DESIGNATION OF BENEFICIARY
Name
Social Security No.
(As it appears on TRS records)
Complete this form TRS 15 to designate a beneficiary or beneficiaries for active member death benefits or retiree
survivor benefits. Please read the Instructions and Information for Designating a Beneficiary on the reverse side
for important information about completing this form and how TRS will use this form.
PRIMARY BENEFICIARY OR JOINT PRIMARY BENEFICIARIES
I designate the following person(s) as my primary beneficiary(ies) to receive the benefits described above that may
be due from TRS upon my death (surviving designated joint primary beneficiaries will receive equal portions, share
and share alike):
Name
Social Security No.
Relationship
Date of Birth
Address
ALTERNATE BENEFICIARY OR JOINT ALTERNATE BENEFICIARIES
In the event the primary beneficiary(ies) predeceases me, waives the benefits, or is ineligible to receive the benefits,
I designate the following person(s) as my alternate beneficiary(ies), to receive the benefits described above that
may be due from TRS upon my death (surviving designated joint alternate beneficiaries will receive equal portions,
share and share alike):
Name
Social Security No.
Relationship
Date of Birth
Address
A blank designation of beneficiary on a TRS form that is signed by you revokes any previous designation for the
applicable benefits and leaves no designation of beneficiary. When no beneficiary is designated, applicable
law determines who will receive benefits after your death.
Signature of Member or Retiree
STATE OF
On
(date)
a notary public.
Signature of Notary Public
Date
COUNTY OF
, (printed name of person whose signature appears above) acknowledged this document before me
(SEAL)
This form TRS 15 cannot be used to designate a beneficiary(ies) for monthly retirement benefits under an optional
retirement payment plan (Option 1, 2, 3, 4, or 5). If you wish to change your beneficiary under an optional retirement payment plan, request a Change of Beneficiary for Continuing Optional Retirement Annuity form from TRS.