Beneficiary Designation | ASEA

top of page

About
Membership
Retirees
Contact
More

Use tab to navigate through the menu items.

Home
New Home
About
Membership
Products/Services
Retirees
Info
Contact
More

Use tab to navigate through the menu items.

1301 West 7th St. Little Rock, AR 72201 501.378.0187

Arkansas State Employees Association

PO Box 1588 | Little Rock, AR 72203

First name*

Last name*

Employment*

Name of agency if active, or Retired if retired

Home Address*

Email*

Phone*

Beneficiary 1*

Must be at least 18 years of age

Relationship*

Percentage *

You may designate up to two additional beneficiaries. Make sure that your percentages equal 100%.

Beneficiary 2

Must be at least 18 years of age

Beneficiary 3

Must be at least 18 years of age

Signature*

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Please email me a copy of my completed form for my records.

Beneficiaries: Contact ASEA at 501-378-0187 for assistance.

© Arkansas State Employees Association. All rights reserved. Website designed by Creative Instinct.

bottom of page