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Form ben designation form 2026

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The document is a Beneficiary Designation Form (HR-BEN-034) used to update, add, or change beneficiary designations for life insurance coverage. It includes sections for employee information, beneficiary designation details, and authorization. Employees are instructed to submit the signed form via fax or email and can contact the MTA Business Service Center for assistance.

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Click ‘Get Form’ to open the Beneficiary Designation Form in our editor.
Begin by filling out Section 2, Employee Information. Enter your full name, BSC ID, agency, and contact details including phone numbers and email address.
In Section 3, select the appropriate boxes for the Benefit Plan(s) you wish to update. This includes Basic Life/ADD, Supplemental Life, or Dependent Life.
Proceed to Section 4 for Beneficiary Designation. Clearly print the names of your primary and contingent beneficiaries. Indicate their percentage of benefits, date of birth, social security number, relationship to you, and home address.
Finally, complete Section 5 by signing and dating the form to authorize the changes. Ensure all information is accurate before submission.

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