How make changes:

Click on the link above for a printable version of the Beneficiary Form and follow these instructions for completing the MPRA Beneficiary Form:

1. BENEFICIARY NAME
   • Fill in the full name including the middle initial
2. SEX
   • Fill in the sex, noting (M) for male and (F) for female
3. BIRTH DATE
   • Fill in the complete date of birth (month, day, and year)
4. PERCENTAGE
   • Fill in the percentage of the benefit you want this beneficiary to receive
   • If you only list one beneficiary, you would indicate that person to receive 100%
   • If you list more than one primary OR more than one secondary beneficiary, indicate what percentage each person is to receive. The total must equal 100%.
5. RELATIONSHIP
   • Fill in the beneficiary’s relationship with the member (eg son, spouse, friend, etc)
6. TYPE
   • Fill in the letter “P” for primary beneficiary or letter “S” for secondary beneficiary
7. MAILING ADDRESS and EMAIL ADDRESS
   • Fill in your beneficiary’s mailing address and email address

FINAL STEPS:

-Sign and print your name and fill in your sex, date of birth, your address and telephone number

-Have two witnesses sign the form. A witness cannot be a beneficiary

-Mail the completed form to the MPRA Office at the address listed on the form