Beneficiary Forms


Defined Benefit Beneficiary Forms

Active and Deferred Members Beneficiary Designation
02-822 [PDF 948K]
Designation of Beneficiary for Unpaid Compensation (State of AK employees only)
dbuncp [PDF 29K]
PERS Voluntary Employee Savings Plan Beneficiary Designation
pers051 [PDF 120K]

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Defined Contribution Beneficiary Forms

Deferred Compensation Plan Beneficiary Designation
236358635 [PDF 163K]
Supplemental Annuity Plan Beneficiary Designation
236358645 [PDF 163K]
DCR Plan PERS Beneficiary Designation
236358653 [PDF 162K]
DCR Plan TRS Beneficiary Designation
236358661 [PDF 162K]

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Employee Health and Optional Benefits Beneficiary Forms

Basic and Select Life Insurance Enrollment or Change form
5-301a [PDF 150K]
Optional Benefit Beneficiary
02-1841 [PDF 291K]
SBS Political Subdivision Beneficiary Designation (Life, AD&D, Survivor)
ben013 [PDF 55K]

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Retiree Health and Optional Benefits Beneficiary Forms

Retiree Beneficiary Designation
02-822a [PDF 108K]
Retirees Select/Optional Life Insurance Continuation/Waiver
02-1858 [PDF 127K]

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