FormsStaffBenefits → Designation of Beneficiary/Beneficiaries

Designation of Beneficiary/Beneficiaries

About this Form

Form number: 455-5

Audience:  MCPS Staff

Last revised: August 2015

INSTRUCTIONS:

This form is to be used by MCPS staff ONLY to update their MCPS Core and/or Supplemental Pension Plan beneficiary/beneficiaries.  

Please return completed form to the Employee and Retiree Service Center, Montgomery County Public Schools, 45 West Gude Drive, Suite 1200, Rockville, Maryland 20850.  Print clearly. Retain a copy for your records.

Adobe PDF Designation of Beneficiary/Beneficiaries432 KEnglish

Forms require Adobe Acrobat Reader 8 or higher. Get Acrobat