Public Employees Retirement Association of New Mexico

PERA Refund Beneficiary Form

Important Information You Should Know About Completing a PERA

Refund Beneficiary Form

Public Employees Retirement Association of New Mexico

Frequently Asked Questions

A one-time refund benefit is paid by PERA in the event of your non-duty death.

You may only choose either one person or one organization as your Refund Beneficiary.

If you and your beneficiary pass away at the same time your account (your member contributions and the interest) will be refunded to your estate.

Public Employees Retirement Association of New Mexico

Member Information Section

999-99-9999 01/01/1960

Mary Smith

505-222-1234

P. O. Box 111

Albuquerque NM 87000 XX

X

Public Employees Retirement Association of New Mexico

Beneficiary Information Section

John Smith Spouse 888-88-8888 02/02/1959 P. O. Box 111, Albuquerque, NM 87000505-222-1234

ORThe Organization’s Name Address / Telephone Number 123-45-6789

John Smith Mary Smith

The Organization’s Name

January 1, 2008John Smith

Public Employees Retirement Association of New Mexico

Member Authorization Section

Mary Smith 01/01/2008

Santa Fe

Mary Smith 1 January 2008

06/10/2010 505-123-1234

Maria Trujillo

Public Employees Retirement Association of New Mexico

Completing the Form

Once you have completed the form: Make a copy for yourself, Give a copy to your employer, and Send the original form to PERA.

You may check the PERA website www.pera.state.nm.us after 4 - 6 weeks to see if your beneficiary information has been added/changed.

If you have any questions concerning this form or any other issue, please contact PERA at 1-800-342-3422.