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Service Retirement Application

Customer Name: JOHN DOE

Your Defined Benefit (DB) with a Compound Option Beneficiary Election

Complete the form below by filling out About Your Option Beneficiary and Your Option Beneficiary’s Contact Information. Once you have filled out the form below, select the Next button to continue.

Add Your Option Beneficiary's Information

Beneficiary 2 of 2


About Your Option Beneficiary

* Beneficiary Option:  
* First Name:  
Middle Initial:  
* Last Name:  
* Gender:  
* Relationship to Member:  
* Date of Birth:   calendar
* Social Security Number:  
Member of CalSTRS:  


Your Option Beneficiary's Contact Information

* USA or International Address:   USA International
* Street Address:  
Apartment/Condo/Suite #:  
* City:  
* State:  
* Zip Code:   -
Primary Phone Number:   () - Ext.
Alternate Phone Number:   () - Ext.
Fax Number:  
* E-Mail Address:  
* Confirm E-Mail Address:  


*Required fields to continue.
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