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Designation of Beneficiary/Beneficiaries

About this Form

Form number: 455-5

Audience:  MCPS Staff

Last revised: October 2019


This form is to be used by MCPS staff ONLY to update their MCPS Core and/or Supplemental Pension Plan beneficiary/beneficiaries.  

Please return completed form to the Employee and Retiree Service Center, Montgomery County Public Schools, 45 West Gude Drive, Suite 1200, Rockville, Maryland 20850.  Print clearly. Retain a copy for your records.

Adobe PDF Designation of Beneficiary/Beneficiaries426 KEnglish

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