VRS-2 (Rev. 02/20)
*VRS-000002*
DESIGNATION OF BENEFICIARY
PART A. MEMBER/RETIREE INFORMATION
3. Name (First, Middle Initial, Last)
4. Are you retired?
Yes No
5. Address (Street, City, State and ZIP+4)
6. Birth Date
PART B. BENEFICIARIES FOR VRS BASIC GROUP LIFE INSURANCE
Check ONE:
I revoke any previous designations and elect payment of VRS basic group life insurance benefits to be made by order of
precedence established by law. If you check this box, do not complete the beneficiary information below. Continue to Part C.
(Order of precedence is explained in the form instructions.)
I revoke any previous designations and elect payment of VRS basic group life insurance benefits to the beneficiaries
designated below. If you check this box, complete the beneficiary information below.
Full Name (Person or Estate) (First, Middle Initial, Last)
Social Security Number
Address (Street, City, State and ZIP+4)
Beneficiary Type (Check one)
Primary Contingent
Share %
Relationship
Birth Date
Full Name (Person or Estate) (First, Middle Initial, Last)
Social Security Number
Address (Street, City, State and ZIP+4)
Beneficiary Type (Check one)
Primary Contingent
Share %
Relationship
Birth Date
Full Name (Person or Estate) (First, Middle Initial, Last)
Social Security Number
Address (Street, City, State and ZIP+4)
Beneficiary Type (Check one)
Primary Contingent
Share %
Relationship
Birth Date
Name of Trust Organization
Date of Trust
Address (Street, City, State and ZIP+4)
Beneficiary Type (Check one)
Primary Contingent
Share %
Are additional Basic Group Life Insurance beneficiaries listed on a VRS-2A continuation form?
Yes No
VIRGINIA RETIREMENT SYSTEM
P.O. Box 2500 Richmond, VA 23218-2500
Toll-free 1-888-827-3847
Fax 804-786-9718
www.varetire.org
1. Social Security Number
2. Employer Code
Clear Form
VRS-2 (Rev. 02/20)
PART C. BENEFICIARIES FOR VRS OPTIONAL GROUP LIFE INSURANCE
Complete this section only if you have optional group life insurance covering yourself.
Check ONE:
I revoke any previous designations and elect payment of VRS optional group life insurance benefits to be made by order
of precedence established by law. If you check this box, do not complete the beneficiary information below. Continue to Part D.
(Order of precedence is explained in the form instructions.)
I revoke any previous designations and elect payment of VRS optional group life insurance benefits to the beneficiaries
designated below. If you check this box, complete the beneficiary information below; or:
Check here if you want the beneficiaries for optional group life to be the same beneficiaries you designated in Part B for basic
group life insurance. (If you check this box, you may leave Part C blank and VRS will pay optional life insurance benefits
according to the designations made in Part B.)
Full Name (Person or Estate) (First, Middle Initial, Last)
Social Security Number
Address (Street, City, State and ZIP+4)
Beneficiary Type (Check one)
Primary Contingent
Share %
Relationship
Birth Date
Full Name (Person or Estate) (First, Middle Initial, Last)
Social Security Number
Address (Street, City, State and ZIP+4)
Beneficiary Type (Check one)
Primary Contingent
Share %
Relationship
Birth Date
Full Name (Person or Estate) (First, Middle Initial, Last)
Social Security Number
Address (Street, City, State and ZIP+4)
Beneficiary Type (Check one)
Primary Contingent
Share %
Relationship
Birth Date
Name of Trust Organization
Date of Trust
Address (Street, City, State and ZIP+4)
Beneficiary Type (Check one)
Primary Contingent
Share %
Are additional Optional Group Life Insurance beneficiaries listed on a VRS-2A continuation form?
Yes No
Social Security Number
VRS-2 (Rev. 02/20)
PART D. BENEFICIARIES FOR VRS DEFINED BENEFIT MEMBER ACCOUNT RETIREMENT CONTRIBUTIONS/
BENEFITS
Check ONE:
I revoke any previous designations and elect payment of VRS defined benefit retirement contributions/benefits to be
made by order of precedence established by law. If you check this box, do not complete the beneficiary information below.
Continue to Part E. (Order of precedence is explained in the form instructions.)
I revoke any previous designations and elect payment of VRS defined benefit retirement contributions/benefits to the
beneficiaries designated below. If you check this box, complete the beneficiary information below.
Full Name (Person or Estate) (First, Middle Initial, Last)
Social Security Number
Address (Street, City, State and ZIP+4)
Beneficiary Type (Check one)
Primary Contingent
Share %
Relationship
Birth Date
Full Name (Person or Estate) (First, Middle Initial, Last)
Social Security Number
Address (Street, City, State and ZIP+4)
Beneficiary Type (Check one)
Primary Contingent
Share %
Relationship
Birth Date
Full Name (Person or Estate) (First, Middle Initial, Last)
Social Security Number
Address (Street, City, State and ZIP+4)
Beneficiary Type (Check one)
Primary Contingent
Share %
Relationship
Birth Date
Name of Trust Organization
Date of Trust
Address (Street, City, State and ZIP+4)
Beneficiary Type (Check one)
Primary Contingent
Share %
Trustee or Organization Executive Officer
Are additional VRS Defined Benefit beneficiaries listed on a VRS-2A continuation form?
Yes No
PART E. CERTIFICATION
Member Certification: I do hereby revoke all previous designations of primary and contingent beneficiaries, if any, and designate the
beneficiary(ies) as indicated on this form to receive the proceeds of the basic and optional group life and accidental death and
dismemberment insurance policies administered by VRS if I am covered under those policies, and to receive the accumulated
retirement contributions/benefits to my credit in VRS at the time of my death. I do hereby direct that should I survive all of the above-
named primary and contingent beneficiaries, any amount(s) which otherwise would have been payable to such beneficiary(ies) shall be
paid in the order of precedence established by law and as listed in the instructions of this form or to such other beneficiary(ies) as I
shall hereafter designate by written designation filed with the VRS Board of Trustees in accordance with its procedures. The right to
change the beneficiary(ies) designation without the consent of said beneficiary(ies) is reserved. All information I provide in this
document is true and I understand that any willful falsification of facts presented may result in prosecution as provided by law. (Persons
holding a Power of Attorney, acting under a Guardianship, or acting as a Trustee may not make or change any beneficiary designation
unless the relevant documentation specifically grants the authority to do so. Persons not holding such documents may not make or
change any member’s beneficiary designation unless granted the authority to do so by court order.)
Member Signature Date
Social Security Number
VRS-2 (Rev. 02/20)
INSTRUCTIONS FOR COMPLETING THE DESIGNATION OF BENEFICIARY
Complete this form to designate a beneficiary for VRS Basic and Optional Group Life Insurance and for your defined
benefit retirement contribution account. It is only necessary to designate a beneficiary if you want payment to be made by
means other than the order of precedence established by law. If you previously completed a VRS-2 and wish to change
beneficiaries or now wish to choose the order of precedence, you must complete this form to revoke any prior
designations.
Please read the information provided on this form to understand your options for designating a beneficiary. Additional
information is provided in your Handbook for Members, which is available at www.varetire.org or from your human
resources representative.
Order of Precedence
You may choose the order established by law to provide payment of your benefits or you may designate specific
beneficiaries to receive your benefits in the event of your death. The order of precedence is as follows:
To your spouse;
If no surviving spouse, to the children* of the member and descendants of deceased children, per stirpes;
If none of the above, to your parents equally or to the surviving parent;
If none of the above, to the duly appointed executor or administrator of your estate;
If none of the above, to your next of kin under the laws of the state where you reside at the time of your death.
*Children means all children except stepchildren, foster children, minors who happen to be living with the member,
and individuals raised by the deceased member as a “child.”
Life Insurance Benefits
Your VRS Basic and Optional Group Life Insurance benefits will be paid by order of precedence unless otherwise
indicated in Parts B and C of this form.
Defined Benefit Retirement Benefits
Death in Service:
If you are vested (have at least five years of service credit) and die while in service with a VRS-covered employer and
your death is not work-related, VRS pays retirement benefits as follows:
If no designation is made, or the death of all primary and contingent designated beneficiaries occurs prior to your
death and another designation is not made, the beneficiary is determined by order of precedence.
If you name your spouse, minor child(ren), or parent(s) as a beneficiary, or they are deemed the beneficiary by order
of precedence, that person may receive a monthly benefit or may elect a refund of the contributions and accrued
interest in your account to the exclusion of any other named beneficiary. The spouse will take precedence over a
minor child, a minor child will take precedence over a parent.
If the beneficiary named, or determined by order of precedence, is someone other than your spouse, minor child(ren),
or parent(s), a refund of the contributions and interest credited to your account is paid.
If you are not vested and die while in service with a VRS-covered employer and your death is not work-related, VRS pays
defined benefit retirement benefits in the form of a refund to your designated beneficiary.
If you die while in service with a VRS-covered employer, and your death is work-related, VRS pays defined benefit
retirement benefits as follows regardless of whether or not you are vested:
A refund of contributions and interest is paid to your designated beneficiary. If no designation is made, or the death of
all of your primary and contingent designated beneficiaries occurs prior to your death and another beneficiary is not
designated, the contributions and interest credited to your account are refunded to the beneficiary as determined by
order of precedence.
In addition to the refund of contributions and interest, a monthly benefit is paid to your surviving spouse for life. If you
have no surviving spouse, the monthly benefit is paid to your minor child(ren) until age 18. If you have no minor
child(ren), the benefit is paid to your parent(s) for life. All benefits are governed by and subject to the Virginia
Retirement Act (Code of Virginia Title 51.1)
VRS-2 (Rev. 02/20)
Death After Retirement:
If you die after your effective date of retirement and chose a payout option other than a Survivor Option, a refund of the
contributions and interest that have not been paid to you as a monthly retirement benefit is refunded to your named
beneficiary or, if no beneficiary designation is on file with VRS, to the first person qualifying by order of precedence.
If you die after your effective date of retirement and chose a Survivor Option, your monthly retirement benefit payment
continues to the person you named as your contingent annuitant.
If you are retired, selected a survivor option and wish to change the name of the person you selected to receive the
monthly benefit at the time of your death, contact VRS for further information. This form cannot be used to change the
contingent annuitant you designated at retirement.
Death After Separation:
If you die after you have separated from employment in a VRS-covered position but before beginning to receive a monthly
retirement benefit and you have not taken a refund of the contributions and interest credited to your account prior to your
death, a refund of the contributions and interest credited to your account is paid to your named beneficiary; or if no
beneficiary designation is on file, to the first person qualifying by order of precedence.
Other Key Points to Remember
1. This form is not used to designate a beneficiary for any defined contribution account funds that you may have as a part
of your covered employment. Contact your defined contribution plan provider directly to designate beneficiaries.
2. This form cannot be used to designate a beneficiary for your spouse’s or children’s coverage under the Optional Life
Insurance Plan because you are the beneficiary of those benefits.
3. If you name multiple primary beneficiaries, other than those established by law for death in service benefits, the
proceeds will be split equally, unless you instruct otherwise in the Share % box for each beneficiary on this form. If you
need to designate additional beneficiaries, list them on the Designation of Beneficiary Continuation (VRS-2A) at the
time you complete the VRS-2 and send both forms to VRS.
4. Complete the form using full names such as “Mary L. Doe” rather than “Mrs. John Doe.”
5. If a minor (child less than 18 years of age) is named as beneficiary, a guardian for the financial estate of the minor must
be appointed by the court before benefits can be paid.
6. If an estate is named as beneficiary, a probated will appointing an administrator or executor must be provided or the
court must appoint an administrator or an executor before benefits can be paid.
7. If a trust is named as beneficiary, list the name of the trustee and the date that the trust agreement was completed. Do
not submit a copy of the trust with this form. A copy will be requested when the claim for benefits is made.
8. Forms that have been altered cannot be accepted. If you make an error when completing this form, complete a new
form.
9. Beneficiary Types: When you choose beneficiaries, you must indicate whether each beneficiary is a primary or
contingent beneficiary.
Primary: Person(s) to receive the death benefits payable upon your death.
Contingent: Person(s) to receive the death benefits payable upon your death, if the primary beneficiary(ies) dies
before you.
9. Share %: You may provide less than 100% share to an individual beneficiary and you may break down the shares
designated for each benefit differently. Be sure your share percentages total 100% for each type of benefit.
VRS-2 (Rev. 02/20)
Completing the Form
Part A. Member/Retiree Information
Enter your personal information in boxes 1 though 6 on page 1, and provide your Social Security number at the bottom of
each subsequent page. The employer code is required in box 2 only if you are an active VRS member.
Part B. Designation of Beneficiary for VRS Basic Group Life Insurance
Check the appropriate box to indicate whether you wish to have payment of basic group life insurance be made by order
of precedence or have the payment made to beneficiaries you designate.
If you choose to designate beneficiaries, enter each beneficiary’s full name, Social Security number and complete address
as well as whether the beneficiary is primary or contingent, the person’s relationship to you, the percentage of life
insurance to be paid to the person, and his or her birth date.
Part C. Designation of Beneficiary for VRS Optional Group Life Insurance
Check the appropriate box to indicate whether you wish to have payment of optional life insurance be made by order of
precedence or have the payment made to beneficiaries you designate.
If you choose to designate beneficiaries that are different that the beneficiaries you designate for your basic group life
insurance, enter each beneficiary’s full name, Social Security number and complete address as well as whether the
beneficiary is primary or contingent, the person’s relationship to you, the percentage of life insurance to be paid to the
person, and his or her birth date.
Part D. Designation of Beneficiary for Accumulated VRS Defined Benefit Retirement Contributions/Benefits
Check the appropriate box to indicate whether you wish to have payment of VRS retirement contributions/benefits be
made by order of precedence or have the payment made to beneficiaries you designate.
If you choose to designate beneficiaries, enter each beneficiary’s full name, Social Security number and complete address
as well as whether the beneficiary is primary or contingent, the person’s relationship to you, the percentage of retirement
contributions/benefits to be paid to the person, and his or her birth date.
Part E. Certification
Sign and date the member certification. Remember to keep a copy of the completed form for your records before you
send the form to VRS.
Also remember any Designation of Beneficiary Continuation (VRS-2A) that you complete must be sent along with the
Designation of Beneficiary (VRS-2). VRS must receive both forms in the same mailing.
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