• If you need to change any of the information on this form after submitting it; TRS must receive the changes no later than one business day before the annuitization date you elect. However, you may change your payment option election up to 30 days after your effective annuitization date by filing the TDA Annuitization Option Change Form (code RW87). You may cancel your form by submitting a Cancellation Request Form (code MI5). TRS must receive this form at least one day before your effective annuitization date, regardless of the date on which you submitted the form. Please note that you may NOT cancel your TDA Annuitization Election Form on or after your effective annuitization date, and withdrawals from your TDA account may not be made on or after your effective annuitization date.
• You should keep TRS informed of any change to your beneficiaries' mailing addresses by notifying us in writing.
• If you require additional assistance, please contact our Member Services Center at 1 (888) 8-NYC-TRS (869-2877).

In some cases, you must submit proof of your beneficiary’s date of birth. The following items are considered acceptable proof of date of birth, and only one of the following is required: birth certificate; passport; or naturalization document. If none of these items is available, then two of the following are required: driver’s license; certificate of military record; Form SSA-2458 (Report of Confidential Social Security Benefit Information); or other government-issued identification. For members annuitizing on or after January 1, 2022, there are additional documentation requirements for Continuing Payment Options, in accordance with the federal SECURE Act: Proof of the beneficiary’s date of birth in all cases; proof of marriage (i.e., marriage license); or proof of your beneficiary’s disability/chronic illness, as applicable. After you submit this form, you will be directed to a screen where you can upload documents. A Member Services Representative will contact you to review the completeness of your filing.

All information must be provided.

Please select one of the statements to designate your annuitization date.

You must elect ONLY ONE payment option in Part C for your monthly annuity payments and designate beneficiaries if your payment option includes that provision. In all cases, you would receive your monthly annuity payments for as long as you live. If you want to provide for beneficiaries, you have several choices, each of which would reduce the amount of your monthly annuity payments. All payments to you and your beneficiaries are monthly and each payment option also enables you to choose a beneficiary for the fractional amount of your retirement allowance. You may add additional beneficiaries in the secure section of our website. For additional information about payment option elections and beneficiaries, please see the Retirement Payment Options: Tiers l/ll and TDA Annuitization Options brochure. See Required Documentation section above for acceptable documents to prove your beneficiary's date of birth. Please note that you may designate a trust only for lump-sum payments.

Your payment options are categorized as follows:

If you elect a Continuing Payment or Pop-up Option:

• These options provide for only one beneficiary. You may change this beneficiary designation up to 30 days after your initial payability date.
• Your beneficiary's age is a factor in computing the amount of your monthly annuity payments; therefore, you must submit proof of your beneficiary's date of birth in conjunction with this application.
• You may not designate a trust as your beneficiary.

Note: If you annuitize on or after January 1, 2022, please note the following requirements for Continuing Payment Options, in accordance with the federal SECURE Act: Your beneficiary must meet at least one of the following criteria:

• must be your spouse; OR
• must not be more than 10 years younger than you; OR
• must be chronically ill or disabled, as defined under the applicable sections of the Internal Revenue Code.

Otherwise, you may not elect a Continuing Payment Option for your TDA annuity.

In addition to any election you may have made in Part C, you must designate a beneficiary in Part D to receive any fractional payment that may be due for the month in which you die. The fractional payment would be payable provided that you do not die on the last day of the month; the payment would be based on the number of days that you are alive during that month. For example, if you die on the 21st day of a 30-day month, the beneficiary that you designate would receive a payment equaling 21/30 (or 70%) of your monthly annuity.

• The beneficiary you designate to receive your fractional payment need not be the same beneficiary as you designate in Part C.
• You may change your fractional beneficiary designation at any time after you file the TDA Annuitization Election Form in the secure section of our website.
• If you have already established a trust, you may designate your trust as your beneficiary.
• If your beneficiary predeceases you, the fractional payment would be made to your estate.

At annuitization, you have the opportunity to reallocate your accumulated TDA funds among TRS’ Passport Funds. If you elect to do so, investment allocation changes need to be in multiples of 5% and must total 100%. The example below demonstrates how to complete Part E if you would like to invest 50% of your TDA funds in the Fixed Return Fund, 10% each in the Diversified Equity Fund and the U.S. Equity Index Fund, and 15% each in the Balanced Fund and the Sustainable Equity Fund. (This is only an illustration, not a recommendation.) Your TDA funds will be reallocated on your initial payability date according to the percentages you indicate on this application.

Note: Any ongoing conversion of your funds that is not completed by your initial payability date would stop as of that date. You may change the way your TDA funds are invested, on a quarterly basis, by filing a TDA Annuitant's Investment Election Change Form (code RP9) with TRS at any time. Investment election changes take effect on the following conversion dates: April 1, July 1, October 1, and January 1. Your elections would take effect on the next conversion date that occurs at least 60 days after TRS receives your form. Please be advised that investment election changes cannot be effected until the quarter after your TDA annuity has been finalized.

After reading the Terms & Conditions, check the box, and then enter your full name.