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Service Retirement Application

Customer Name: JOHN DOE

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

Review your DB with a Compound Option Beneficiary Election on file with CalSTRS. Select the Edit link if you wish to update Your Option Beneficiary’s Contact Information and/or select Next to continue.

Review Your Current Option Beneficiary Election

Beneficiary 2 of 2


About Your Option Beneficiary

  Beneficiary Option:   50%  
  Beneficiary's Name:   John A Doe  
  Gender:   Male  
  Relationship to Member:   Spouse  
  Date of Birth:   03/20/1987  
  Social Security Number:   XXX-XX-7890  
  Member of CalSTRS:   No  
 
  *Is this relationship still current?  
 

Yes No

  


Your Option Beneficiary's Contact Information

  Mailing Address:   1234 West Street
Funtown, CA 95866		 Edit
  Primary Phone Number:   999-888-5555  
  Alternate Phone Number:   999-222-5555  
  Fax Number:   999-888-6666  
  E-Mail Address:   JohnD22@yahoo.com  
 
Consider This
Changes to any beneficiary information listed above, except for Mailing Address and Primary Phone Number must be submitted to CalSTRS in hard copy by U.S. Postal Service, fax or hand-delivery to a local CalSTRS counseling office. external link

You must submit this Preretirement Election of an Option application containing these changes prior to your retirement date to be valid.


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