State of Alaska
Department of Administration
Division of Retirement and Benefits
Beneficiary Forms
- Defined Benefit Beneficary Forms
- Active and Deferred Defined Benefit Plan Members
- Defined Contribution Beneficiary Forms
- Defined Contribution Retirement (DCR) Plan PERS Tier IV/TRS Tier III
- Deferred Compensation Plan
- Supplemental Annuity Plan
- Health and Optional Benefits 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]
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]
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]
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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