TR-0279 (Rev. 6/18) RDA-413
Please complete this form if you are currently drawing a pension and would like to change your
beneciary(s) on le with the Tennessee Consolidated Retirement System (TCRS).
SECTION 1. MEMBER INFORMATION
Member ID Last 4 SSN XXX-XX- Date of Birth
Full Name
Mailing Address
City State Zip Code
Email Phone Number
CHANGE OF BENEFICIARY AFTER RETIREMENT
Tennessee Consolidated Retirement System
Tennessee Department of Treasury
502 Deaderick Street • Nashville, TN 37243-0201 • 800.922.7772 • RetireReadyTN.gov
SECTION 1. MEMBER INFORMATION
A retired employee may change his/her beneciary under the following circumstances:
1. Member Only Plan: An employee who retired under the Regular Maximum Plan may change his/her
beneciary(s) at any time.
2. Optional Plan: An employee who retired under an Optional Plan (Option 1-4) may change his/
her beneciary(s) upon the death of the beneciary(s). Further, an employee may change his/her
beneciary(s) in the event of divorce where the spouse is the designated beneciary, provided that
such cancellation does not conict with the nal divorce decree or marital dissolution agreement.
An employee who desires to change his/her beneciary(s) due to divorce must furnish proper docu-
mentation to TCRS, which shall include the nal decree and marital dissolution agreement. (Please
Note: The retiree’s retirement benet will not be recalculated as a result of the change nor will the
new beneciary be entitled to monthly benets upon the retiree’s death. The new beneciary(s) will
only be entitled to any excess contributions remaining in the retiree’s account at the time of death
or the last check to be paid in the month of death.)
3. Under Either Plan: A retired employee may designate one or more person(s) to serve as bene-
ciaries. A “person” means any individual, rm, organization, partnership, association, corporation,
estate or trust.
SECTION 2. NAMING NEW BENEFICIARY
TR-0279 (Rev. 6/18) RDA-413
I request the Tennessee Consolidated Retirement System to pay any benets due to me in the event
of my death to the beneciary(s) designated below.
Beneciary #1
Full Name
Mailing Address
City State Zip Code
Beneciary’s Date of Birth Beneciary’s SSN
Relationship to TCRS Member Gender □ Male □ Female
Beneciary #2
Full Name
Mailing Address
City State Zip Code
Beneciary’s Date of Birth Beneciary’s SSN
Relationship to TCRS Member Gender □ Male □ Female
Beneciary #3
Full Name
Mailing Address
City State Zip Code
Beneciary’s Date of Birth Beneciary’s SSN
Relationship to TCRS Member Gender □ Male □ Female
Member’s Signature Date