INSTRUCTIONS: ALABAMA BENEFICIARY DESIGNATION RSA-1 AND PEIRAF Alabama public employees enrolled in either the RSA-1 or PEIRAF retirement funds should file a beneficiary designation to appoint beneficiaries to whom funds will be disbursed in the event of their death. This beneficiary designation form can be obtained from the website maintained by the Retirement Systems of Alabama. Alabama Beneficiary Designation RSA-1 And PEIRAF Step 1: At the top left-hand corner, indicate with a check mark whether you are enrolled in the RSA-1 or PEIRAF program. Alabama Beneficiary Designation RSA-1 And PEIRAF Step 2: On the first blank line, enter your first name, middle or maiden name and last name. Alabama Beneficiary Designation RSA-1 And PEIRAF Step 3; On the second blank line, enter your street address or PO box number. Alabama Beneficiary Designation RSA-1 And PEIRAF Step 4: On the third blank line, enter your city, state and zip code. Alabama Beneficiary Designation RSA-1 And PEIRAF Step 5: On the fourth blank line, enter your Social Security number. Alabama Beneficiary Designation RSA-1 And PEIRAF Step 6: On the fifth blank line, enter your phone number. Alabama Beneficiary Designation RSA-1 And PEIRAF Step 7; If you are including beneficiary information on both sides of the page, check the line stating so. Alabama Beneficiary Designation RSA-1 And PEIRAF Step 8: The first section allows you to name up to three primary beneficiaries who will receive your benefits providing they survive you. The format for naming each beneficiary. In the first blank line for each primary beneficiary, enter their name. Alabama Beneficiary Designation RSA-1 And PEIRAF Step 9: In the second blank line for each primary beneficiary, enter their relationship to you. Alabama Beneficiary Designation RSA-1 And PEIRAF Step 10: In the third blank line for each primary beneficiary, enter their date of birth. Alabama Beneficiary Designation RSA-1 And PEIRAF Step 11: In the fourth blank line for each primary beneficiary, enter their Social Security number. Alabama Beneficiary Designation RSA-1 And PEIRAF Step 12: In the fifth blank line for each primary beneficiary, enter their address. Alabama Beneficiary Designation RSA-1 And PEIRAF Step 13: Follow the same format to name all contingent beneficiaries who will inherit in case your primary beneficiaries do not survive you. Alabama Beneficiary Designation RSA-1 And PEIRAF Step 14: Sign and date the form before a notary public.