INSTRUCTIONS: ALABAMA BENEFICIARY DESIGNATION (Form RSA-1 PEIRAF)

Alabama public employees enrolled in the state-administered RSA-1 or PEIRAF retirement plans use the form discussed in this article to designate primary and contingent beneficiaries for their benefits in the event of their death. This document can be obtained from the website maintained by the Retirement Systems of Alabama.

Alabama Beneficiary Designation RSA-1 PEIRAF Step 1: Indicate whether you maintain a PEIRAF or RSA-1 account with a check mark.

Alabama Beneficiary Designation RSA-1 PEIRAF Step 2: On the first blank line, enter your first name, middle or maiden name and last name.

Alabama Beneficiary Designation RSA-1 PEIRAF Step 3: On the second blank line, enter your street address or P.O. box number.

Alabama Beneficiary Designation RSA-1 PEIRAF Step 4: On the third blank line, enter your city, state and zip code.

Alabama Beneficiary Designation RSA-1 PEIRAF Step 5: On the fourth blank line, enter your Social Security number.

Alabama Beneficiary Designation RSA-1 PEIRAF Step 6: On the fifth blank line, enter your phone number.

Alabama Beneficiary Designation RSA-1 PEIRAF Step 7: If documenting additional primary or contingent beneficiaries on the second page, check the box where indicated. This will be the case if designating more than three primary or contingent beneficiaries.

Alabama Beneficiary Designation RSA-1 PEIRAF Step 8: The first section concerns primary beneficiaries. For each, enter their name on the first blank line.

Alabama Beneficiary Designation RSA-1 PEIRAF Step 9: For each beneficiary, enter their relationship to you on the second blank line.

Alabama Beneficiary Designation RSA-1 PEIRAF Step 10: For each beneficiary, enter their date of birth on the third blank line.

Alabama Beneficiary Designation RSA-1 PEIRAF Step 11: For each beneficiary, enter their street address or P.O. box number, city, state and zip code on the fourth blank line.

Alabama Beneficiary Designation RSA-1 PEIRAF Step 12: The next section concerns contingent beneficiaries. For each one, provide their name, relationship to you, date of birth, Social Security number and complete address.

Alabama Beneficiary Designation RSA-1 PEIRAF Step 13: If you require space to document additional primary or contingent beneficiaries, enter your name and Social Security number at the top of the second page and provide all additional information.

Alabama Beneficiary Designation RSA-1 PEIRAF Step 14: Sign and date the first page, then obtain the certification of a notary public.