INSTRUCTIONS: ALABAMA CHANGE OF BENEFICIARY FORM PRIOR TO RETIREMENT (Form RSA 100-C)

Prior to your retirement, if you wish to change the beneficiaries who will receive the accumulated credits from your contributions to your Alabama retirement fund as a state employee in the event of your death, you may do so by filing a form RSA 100-C. This document can be obtained from the website of the Retirement Systems of Alabama. Print or type your answers in black ink. Note that this form should not be used by those who are retired or participants in the DROP program.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 1: Enter your name and Social Security number.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 2: Enter your date of birth.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 3: Enter your home phone number.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 4: Indicate with a check mark if you are an active or inactive member.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 5: The section below is where you name your primary beneficiary. On the first line there, give their name.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 6: On the second line, state their relationship to you.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 7: On the third line, give their date of birth.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 8: On the fourth line, enter their Social Security number.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 9: On the fifth line, give their full address.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 10: You may name additional primary beneficiaries on the second page.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 11: The next section allows you to name a contingent beneficiary in the event that all of your primary beneficiaries are deceased. Provide their name, relationship to you, date of birth, Social Security number and address.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 12: You must sign and date the form in the presence of a notary public.