Designation of Primary and Contingent Beneficiary – Tier 3, Tier 4, and Tier 6
Form #134

Form

For Tier 3, Tier 4, and Tier 6 members who wish to nominate Primary and Contingent beneficiaries to receive a death benefit payable upon the death of a member while in active City service.

Members with a registered MyNYCERS account can manage their beneficiaries online instead of submitting this paper application.