Return completed form to: PO Box 26129 Santa Fe, NM 87502-0129. 1(866) 691-2345 or (505) 827-8030
Instructions for Beneficiary Designation—Form 42
Form must be filled out using blue or black ink only. Copies and/or Forms with white-out will be rejected.
Do NOT complete if retired.
Failure to comply with the instructions will result in an incomplete and rejected form.
Active and inactive (non-retired) members covered by the New Mexico Educational Retirement Board must complete NMERB Form 42
to designate a beneficiary for their account.
See Section 22-11-2 (E) and 22-11-29 (F)(G) & (I) NMSA 1978 and Paragraph (E) & (F) of 2.82.5.13 and Paragraph (B) of 2.82.3.10 NMAC.
Complete Sections I, II or III and IV. If you are married, and designated someone other than your spouse, Section V
MUST be completed and signed by your spouse in the presence of a notary public. If section V is completed, a notary must
notarize this section. Incomplete and/or incorrect forms will be returned to you.
Section II Beneficiary Information Automatic Option B coverage: If you are vested (five or more years of
earned service credit) and die prior to retirement, your named beneficiary may select either a monthly lifetime
benefit (annuity) or a one-time lump sum payment. You can name only one beneficiary for Option B coverage.
Naming more than one beneficiary on this form automatically rejects the Option B coverage. Only a named
beneficiary may select the monthly benefit option, all other beneficiaries are only eligible for a one-time lump sum
payment.
Section III Beneficiary(ies) Information: If you opt out of Option B coverage and die prior to retirement,
your named beneficiary(ies) on this form will receive a one-time lump sum payment.
Complete Section II if you want your beneficiary to qualify for the Option B coverage, as described in §22-11-29 (F) NMSA
1978. Once you are vested (five or more years of earned service credit) and if you die prior to retirement your named
beneficiary will have the choice to either receive a monthly lifetime benefit or a one-time lump sum payment. If you die prior
to having earned five years of service credit, your named beneficiary will receive a one-time lump sum payment.
Complete Section III if you reject the Option B coverage, as described in 22-11-29 (F), for your beneficiary or want to name
more than one beneficiary. Please note that naming more than one beneficiary automatically rejects the Option B coverage
for your beneficiaries. If you want to name more than one beneficiary, you may complete the Beneficiary Designation
—Form 42 Addendum.
Please include any previous names you have had if applicable.
Beneficiary(ies) may be changed any time prior to retirement.
In the event of a divorce it is important that you review your existing Beneficiary Designation form to ensure that the desired
beneficiary(ies) are named. A divorce does not automatically remove your former spouse as your beneficiary. The
Beneficiary Designation Form-42 can be accessed at www.nmerb.org/downloadableforms. * Please be advised that
beneficiary selections are subject to any court orders regarding the division of the community property portion
of your retirement benefit due to divorce. Provide a divorce decree, if you divorced at any point during your NMERB
service.
If you have never earned prior NMERB service and you complete this Beneficiary Designation-Form 42 and are not
reported by any NMERB covered employer within 90 days, this form will be void and will be returned to you.
Upon employment with an NMERB covered entity, this form must be returned to the NMERB.
If you fail to submit a valid beneficiary designation form, any benefits payable upon your death will be paid
to your surviving spouse or domestic partner, or if none, in a one-time lump sum payment to your estate. Proof of
marital status or domestic partnership is required.
Rev. 05/19