Transcription of Complete if applicable Beneficiary Designation
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Complete if applicable Beneficiary Designation
Wisconsin Department of Employee Trust Funds Box 7931 Complete if applicable Madison, WI 53707-7931. 1-877-533-5020 (toll free). Beneficiary Designation Beneficiary of: Fax: (608) 267-4549 Wis. Stat. (8) (a) and Alternate Payee of: Do not submit to your employer Refer to instructions on reverse Type or print in ink Your name First Middle I. Last Former/maiden Your Social Security number or ETF ID. Your address (Street number and street name) Your birth date (MM/DD/CCYY). / /. City State ZIP Code Your weekday telephone number (Include area code).
If you list primary or secondary and/or tertiary beneficiaries, be sure to include the full name, relationship, birthdate, Social Security number
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