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If your beneficiary is a minor, you may use this form to
designate a guardian to claim the benefit on behalf of the minor.
This form may be used in conjunction with any of NYCERS’ Designation of Beneficiary Forms.
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.