Fillable DESIGNATION OF BENEFICIARY CONTINUATION (Virginia Retirement System)

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DESIGNATION OF BENEFICIARY CONTINUATION (Virginia Retirement System)

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VRS-2A (Rev. 02/20)
DESIGNATION OF BENEFICIARY – CONTINUATION
Use this form to designate additional beneficiaries when the number of beneficiaries you desire exceeds the number
allowed on the Designation of Beneficiary (VRS-2).
Complete this form at the same time you complete the VRS-2. This form may only be used at the time a VRS-2 is
completed; you cannot submit a VRS-2A to add to a VRS-2 that is already on file with VRS.
3. Name (First, Middle Initial, Last)
4. Birth Date
PART B. VRS BASIC GROUP LIFE INSURANCE – CONTINUATION
List additional beneficiaries for basic group life insurance in the area below that were not included on the VRS-2 being
submitted with this form.
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
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
1. Social Security Number
VIRGINIA RETIREMENT SYSTEM
P.O. Box 2500 Richmond, VA 23218-2500
Toll-free 1-888-827-3847
Fax 804-786-9718
www.varetire.org
Clear Form
VRS-2A (Rev. 02/20)
PART C. VRS OPTIONAL GROUP LIFE INSURANCE – CONTINUATION
List additional beneficiaries for optional group life insurance in the area below that were not included on the VRS-2 being
submitted with this form.
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
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
Social Security Number
VRS-2A (Rev. 02/20)
PART D. VRS DEFINED BENEFIT MEMBER ACCOUNT RETIREMENT CONTRIBUTIONS – CONTINUATION
List additional beneficiaries for VRS defined benefit member account retirement contributions in the area below that were
not included on the VRS-2 being submitted with this form.
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
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
PART E. CERTIFICATION OF CONTINUATION
Member Certification
This is a continuation of the Designation of Beneficiary (VRS-2) under my signature and dated .
(mm/dd/yyyy)
Member Signature
Social Security Number
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DESIGNATION OF BENEFICIARY CONTINUATION (Virginia Retirement System)

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Completed 19 July 2021

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