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Begin by filling out your general information in Section 1. Provide your last name, first name, middle name, and any other names used. Enter your Social Security Number, date of birth, gender, mailing address, email, and phone numbers clearly.
Indicate your relationship to the participant in the plan by marking the appropriate box (Self, Beneficiary, Alternate payee, or Other). If you select 'Self', proceed to Section 2.
In Section 2, if applicable, provide details about your employment status and spouse information at retirement. Include their names and Social Security Number if required.
Complete Section 3 by designating beneficiaries for any potential payments owed at your death. Fill in their names and relationships accurately.
Finally, sign and date the application in Section 4 to confirm that all provided information is true.
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This form is one part of an application for benefits from the Disability Income Plan of North Carolina. N.C. Department of State Treasurer, Retirement SystemsRead more
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