000295000000000G 2026

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The document is a Life Insurance Beneficiary Designation form for State Employees, State Police, and Judges in Michigan. It allows members to designate primary and contingent beneficiaries for their life insurance benefits, providing instructions on how to fill out the form, including naming beneficiaries, specifying percentage shares, and the implications of divorce on beneficiary designations. The form must be notarized before submission to the Michigan Office of Retirement Services.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information in the designated fields, including your name, member ID or SSN, mailing address, daytime telephone number, city, state, ZIP code, and email address.
In Section I, list your primary beneficiary's details. Include their full name, SSN, birthdate, address, relationship to you, and specify the percentage share if not equal. Ensure that the total of all percentages equals 100%.
Proceed to Section II to designate a contingent beneficiary. Repeat the same process as in Section I for each contingent beneficiary you wish to add.
Finally, review Section III carefully. Do not sign until you are in front of a Notary Public. Once verified, complete the signature and date fields.

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Who can be a beneficiary in Michigan?

You can name your spouse, child, parent, sibling, or grandchild as the beneficiary for your pension. If you have not designated a beneficiary, the monthly benefit is paid to your surviving spouse.

Who do I put for beneficiary designation?

Write the names of the first beneficiary(ies) you would like to receive your benefit after you die. You may name an individual(s), entity (such as a charity, business, religious organization, funeral home, etc.), trust, or estate. You may name more than one.

What is a designation of beneficiary form?

A designation of beneficiary form outlines your desire to have the funds due upon your death paid out in a particular way. There are four types: Type. Form link.

How to fill out beneficiary designation form?

Name only living persons as beneficiaries, unless you are naming a trust, your estate or an organization. Do not name the same person or organization as both a primary and secondary beneficiary. Do not use the word or when designating multiple beneficiaries. Do not impose any conditions on payment.

What is the beneficiary designation form in Michigan?

Beneficiary Designation Forms Submit this form to your Human Resources Office. Final Compensation Beneficiary Designation CS-140 This form is used to assign beneficiaries for final compensation, which can include the last paycheck, payoff of accumulated vacation, sick, comp, longevity, or any other bonuses.