Submit this affidavit if you are unable to produce a birth
certificate or any of the birthdate evidence documents accepted
by NYCERS but can submit three alternative birth records. For a
list of acceptable birthdate evidence, see NYCERS’ Birthdate
Evidence Alternatives Fact Sheet #709.
This form is for the designated beneficiary of a deceased Tier 1
member to elect to receive benefits under Option 1 as an Annuity under Option B. This form also
allows such designated beneficiary to designate a beneficiary to
receive benefits in the event he or she dies.
This form gives the designated beneficiary(ies) of a Tier 2
member who died during active service the opportunity to choose
to receive the Ordinary Death Benefit under Section 448 of
Retirement and Social Security Law as an annuity, rather than as a lump-sum
payment. This form must be filed within 90 days after the date
that NYCERS is notified of the member’s death.