Designating Beneficiary(ies) for Retirement System Contributions - ncdhhs 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section A with your personal information, including your first name, last name, SSN, and mailing address. Ensure all details are accurate and typed in black ink.
3. In Section B, select the appropriate Retirement System that applies to you. Remember that a separate form is needed for each system.
4. Proceed to Section C where you will authorize the Board of Trustees to make payments to your designated beneficiaries. Sign and date this section.
5. Complete Sections G and H by designating your principal and contingent beneficiaries. Provide their names, addresses, and Social Security numbers as required.
6. If necessary, use the continuation page for additional beneficiaries. Make sure no erasures or white-outs are present in any sections.
7. After completing the form, have it notarized as instructed in Section D before submitting it by mail as outlined in Section E.

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