Forms Beneficiaries

Application for COVID-19 Accidental Death Benefit (code DB301)	PDF
COVID-19 Medical Certification A: Date of Onset (To Be Completed by a Medical Professional) (code DB303)	PDF
COVID-19 Medical Certification B: Cause of Death (To Be Completed by a Medical Professional) (code DB304)	PDF

You can designate beneficiaries when you log in with your claim code to file a death benefit claim online.

Please log in with your claim code to file a death benefit claim online.

Claimant's Affidavit for Benefit Under Section 1310 (code DB14)	PDF
Release of Claim Form Under Section 1310 (code DB28)	PDF
Beneficiary's Change of Address Form (code DM14)	PDF
Request for Withdrawal of Form/Application/Online Filing (code MI5)	PDF
Beneficiary's Consent Form for Changes under Section 13-565(c) (code SD27)	PDF

TDA Investment Election Change Form (for Beneficiaries) (code TD81)

Affidavit of Durable Power of Attorney (code BK70)	PDF
TRS Special Durable Power of Attorney (code BK75)	PDF
Model Domestic Relations Order	PDF
Alternate Payee's TDA Direct Rollover Form (code LE25)	PDF

EFT Authorization Form (code BK58)

QPP Direct Rollover Application for Lump-Sum QPP Death Benefit to an Inherited IRA (code DB32b)		PDF
TDA Direct Rollover Application for Lump-Sum TDA Death Benefit to an Inherited IRA (code DB34c)		PDF
1099-R/1099-INT Inquiry Form (code GA5)	online
TDA Withdrawal Application for Beneficiaries (code TD32b)		PDF