Form TSP-3
Designation of Beneciary
October 2013
Thrift Savings Plan
Use this form to designate a beneciary or beneciaries to receive your rift Savings Plan (TSP) account after your death.
If you would like your TSP account to be distributed according to the statutory order of precedence, do not complete this
form. (See the instructions inside for an explanation of the order of precedence.) is Designation of Beneciary form
will stay in eect until you submit another valid Form TSP-3 or you cancel it. e beneciary designation(s) you provide
on this form will automatically cancel all previous designations you submitted. Com plete this form in accordance with
the instructions. Do not alter or change any information you provide on the form. Make a copy of this form for your
records and send the original to the TSP. Do not give this form to your agency or service.
Mail the original to: rift Savings Plan
P.O. Box 385021
Birmingham, AL 35238
Or fax to: 1-866-817-5023
If you have questions, call the toll-free riftLine at 1-TSP-YOU-FRST (1-877-968-3778) or the TDD at 1-TSP-THRIFT5
(1-877-847-4385). Outside the U.S. and Canada, please call 404-233-4400 (not toll free).
You will receive a conrmation of your designation once your form is processed.
For Federal civilian employees, members of the uniformed services, and beneciary participants
Form TSP-3 (10/2013)
PREVIOUS EDITIONS OBSOLETE
FORM TSP-3, INFORMATION AND INSTRUCTIONS FOR PAGE 1
This form stays in effect until you submit another valid Form TSP-3
naming other beneficiaries or cancelling all prior designations. It
does not affect the disposition of any other benefits you may have
such as a FERS Basic Annuity, a CSRS annuity, or military retired pay.
Complete this form only if you want pay ment to be made in a way
other than the following statutory order of precedence:
1. To your spouse;
2. If none, to your child or children equally, and to descendants
of deceased children by representation;
3. If none, to your parents equally or to the surviving parent;
4. If none, to the appointed executor or administrator of your
estate; or
5. If none, to your next of kin who would be entitled to your estate
under the laws of the state in which you resided at the time
of your death.
In this order of precedence, a child includes a natural child (even if
the child was born out of wedlock) and a child adopted by the par-
ticipant; it does not include a stepchild or a foster child who was not
adopted. Note: If your natural child was adopted by someone other
than your spouse, that child is not entitled to a share of your TSP ac-
count under the statutory order of precedence. “By representation”
means that if a child of yours dies before you do, that child’s share
will be divided equally among his or her children. “Parent” does not
include a stepparent unless the stepparent adopted you.
Making a valid designation. To name specific beneficiaries to receive
your TSP account after you die, you must complete this form, and
it must be received by the TSP on or before the date of your death.
Only a Form TSP-3 is valid for designating beneficiaries to your TSP
account(s); a will or court order (i.e., divorce decree) is not valid for
the disposition of a TSP account. You may, however, designate your
estate or a trust as a beneficiary on Form TSP-3.
You are responsible for ensuring that each page of your Form
TSP-3 is properly completed, signed, and witnessed. Do not submit
an altered form; it may be deemed invalid. If you need to correct or
change the information you have entered on the form, start over on
a new form.
Changing or cancelling your Designation of Beneficiary. To cancel a
Form TSP-3 already on file, follow the instructions for Section II.
Keep your designation (and your beneficiaries’ addresses) current. It
is a good idea to review how you have designated your beneficiaries
from time to time — particularly when your life situation changes
(e.g., through marriage, divorce, the birth or adoption of a child, or
the death of a beneficiary).
By law, the TSP must pay your properly designated beneficiary under
all circumstances. For example, if you designate your spouse as a
beneficiary of your TSP account, that spouse will be entitled to death
benefits, even if you are separated or divorced from that spouse or
have remarried. This is true even if the spouse you designated gave
up all rights to your TSP account(s). Consequently, if your life situa-
tion changes, you may want to file a new Form TSP-3 that changes
or cancels your current beneficiary designation.
Unless you designate a contingent beneficiary, the share of any pri-
mary beneficiary who dies before you do will be distributed propor-
tionally among the surviving designated TSP beneficiaries. If none of
your designated beneficiaries is alive at the time of your death, the
order of precedence will be followed.
SECTION I — Participant Information. For this and all sections of
this form, carefully type or print the requested information inside the
boxes using black or dark blue ink.
Check the box that indicates whether you intend your beneficiary(ies)
to receive funds from your civilian, uniformed services, or benefi-
ciary participant account (i.e., an account inherited by the spouse of
a deceased TSP participant). If you have a civilian and a uniformed
services account and want to designate the same beneficiaries and
shares for both accounts, check both boxes. If you have a civilian
and/or uniformed services account in addition to a beneficiary par-
ticipant account, you will need to complete a second Form TSP-3
to designate beneficiaries for your beneficiary participant account.
If you have more than one beneficiary participant account, you will
need to complete a separate TSP-3 form for each beneficiary partici-
pant account since every beneficiary participant account has its own
account number. Note: To avoid the possibility of having your form
rejected, be sure to provide the correct account number (civilian/
uniformed services or beneficiary participant) and check the correct
box(es) that corresponds to the account for which you want to desig-
nate beneficiaries.
If you use an Air/Army Post Office (APO) or Fleet Post Office (FPO)
address, enter your address in the two available address lines (in-
clude the unit designation). Enter APO or FPO, as appropriate, in the
City field. In the State field, enter AE as the state abbreviation for Zip
Codes beginning with 090-098, AA for Zip Codes beginning with 340,
and AP for Zip Codes beginning with 962-966. Then enter the appro-
priate Zip Code.
If you have a foreign address, check the box to indicate that this is a
foreign address and enter the address as follows:
First address line: Enter your street address or post office box num-
ber, and, if applicable, apartment number.
Second address line: Enter the city or town name, other principal
subdivision (e.g., province, state, county) and postal code, if known.
(The postal code may precede the city or town.)
City/State/Zip Code Fields: Enter the entire country name in the City
field; leave the State and Zip Code fields blank.
SECTION II — Cancellation. To cancel a Form TSP-3 already on file
without naming new beneficiaries, check the box in Item 10, sign
and date the form, and have it witnessed. If you check this box, your
account will be paid according to the order of precedence described
earlier. Do not complete this section if you intend to name new ben-
eficiaries in Section IV. Your new designation(s) will automatically
cancel any previous designation(s) on file with the TSP.
SECTION III — Signatures. Sign and date the form on all pages on the
same date. Do not ask the individuals you name as beneficiaries of your
TSP account to witness your Form TSP-3. A person named as a primary
or contingent beneficiary of your TSP account who is also a witness can-
not receive a share of the account. A witness must be age 21 or older.
Incorrect
3 6 9 281
/
/
/
/
3
6
9
1
82
C
RO E CR T
EXAMPLES
CORRECT INCORRECT
Foreign address?
Check here.
City
Zip Code
F R N CA E
Street Address Line 2
Street Address or Box Number
Y
0 6 7 05 P A I SR
A EL2 0 54 R U E R O
–
EXAMPLE OF FOREIGN ADDRESS
State
DESIGNATION OF BENEFICIARY
THRIFT SAVINGS PLAN TSP-3
FORM TSP-3, Page 1 (10/2013)
PREVIOUS EDITIONS OBSOLETE
Do Not Write Below This Line
*PIIS00228701200000000PIIS *
This form is designed to be read by an optical scanner. To ensure that your request is not delayed, carefully type or print the informa-
tion requested using black or dark blue ink. Leave a space between words, but not between the digits in your account number. Type
or print legibly inside the boxes. If you print by hand, use simple block letters. Limit your responses to the number of available boxes.
Do not alter this form or the information you enter. Altered forms may be rejected.
II. CANCELLATION To cancel all previous designations without designating new beneficiaries, check the box below.
In the event of your death, payment from the TSP will be made according to the order of precedence set by the United States
Code (5 U.S.C. § 8424(d)). (If cancelling, submit only Page 1.)
10. Check here only to cancel all prior beneficiary designations without naming new beneficiaries (see instructions for
additional information and complete Section III).
III. SIGNATURES You and your witnesses must complete this section. This entire form is valid only if this page is witnessed
by two persons. A witness must be age 21 or older and cannot be a primary or contingent beneficiary of any portion of this TSP
account. By signing below, the witnesses affirm that the participant: (a) signed in their presence, or (b) informed them that the
signature is the participant’s own signature.
/ /
Date Signed (mm/dd/yyyy)
Witness 2: Signature
Witness 1: Print Full Name
Witness 2: Print Full Name
Participant’s Signature
/ /
Date Signed (mm/dd/yyyy)
Witness 1: Signature
/ /
Date Signed (mm/dd/yyyy)
I. PARTICIPANT INFORMATION
This applies to my: Civilian Account Uniformed Services Account Beneficiary Participant Account
1.
2. 3. 4.
5. 6.
7. 8. 9.
Daytime Phone (Area Code and Number)
–
State
Last Name First Name
Middle Name
City
Zip Code
Street Address Line 2
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
/ /
Date of Birth (mm/dd/yyyy)
TSP Account Number
Foreign address?
Check here.
REMEMBER TO: • Enter your full Name and TSP Account Number at the top of each page.
• Provide your signature and your witnesses’ signatures above, along with the dates signed.
• Sign and date each page that you submit to the TSP.
• Have the same two witnesses sign and date all pages that you submit to the TSP.
• Complete each section in accordance with the instructions.
• Make a copy of this form for your records.
• Mail the completed form to the TSP. Do not submit this form to your agency or service.
Form TSP-3 (10/2013)
PREVIOUS EDITIONS OBSOLETE
FORM TSP-3, INFORMATION AND INSTRUCTIONS FOR PAGE 2
SECTION IV — Primary Bene ficiary Designations. You may name
any person, a trust, your estate, or a legal entity/corporation as a
beneficiary. Note: If the beneficiary is a minor child, benefits will be
made payable directly to the child.
Enter the share for each beneficiary as a whole percentage. Per-
centages for the primary beneficiaries must total 100%. Do not use
fractions or decimals.
To name a primary beneficiary:
• Check the box that indicates the beneciary’s relationship to
you.
• For each individual you designate, enter the full name, share,
address, and date of birth or Social Security number (SSN) or
other tax ID (such as an Employer Identification Number
(EIN)). If providing a foreign address, see Information and
Instructions for Page 1.
• If the beneciary is a trust, check the box marked “Trust.”
Enter the name of the trust and the trustee’s name and ad-
dress in the boxes indicated. Enter the EIN, if available. Leave
the date of birth boxes blank. Note: Filling out this form will
not create a trust; you must have a trust that is already estab-
lished.
• If the beneciary is your estate, check the box marked
“Estate.” Enter the name of the estate and the executor’s
name and address in the boxes indicated. Enter the EIN, if
available. Leave the date of birth boxes blank.
• If the beneciary is a legal entity or corporation, check the
box marked “Legal Entity/Corporation.” Enter the name of the
entity in the boxes indicated. Enter the legal representative’s
name in the boxes marked “Trustee/Executor,” and provide
the legal representative’s address. Enter the EIN, if known.
Leave the date of birth boxes blank.
If you are naming more than 3 primary beneficiaries, photocopy
Page 2 of this form. Enter your name and TSP account number on
the top of each page, and follow the instructions for completing Sec-
tion IV. You must sign and date all additional pages; the same two
witnesses who signed Page 1 must also sign and date all pages,
including any extra pages, that you submit to the TSP.
If you want to designate contingent beneficiaries, complete
Section V on Page 3.
EXAMPLES. Below are examples of how to designate primary
beneficiaries.
EXAMPLES OF DESIGNATING PRIMARY BENEFICIARIES
PRIVACY ACT NOTICE. We are authorized to request the information you pro-
vide on this form under 5 U.S.C. chapter 84, Federal Employees’ Retirement System.
We will use this information to identify your TSP account and to process your request.
In addition, this information may be shared with other Federal agencies for statistical,
auditing, or archiving purposes. We may share the information with law enforcement
agencies investigating a violation of civil or criminal law, or agencies implementing
a statute, rule, or order. It may be shared with congressional offices, private sector
audit firms, spouses, former spouses, and beneficiaries, and their attorneys. We
may disclose relevant portions of the information to appropriate parties engaged in
litigation and for other routine uses as specified in the Federal Register. You are not
required by law to provide this information, but if you do not provide it, we will not be
able to process your request.
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation Share: %
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation Share: %
3 3
A Z
State
T U C S O N
City
8 5 7 3 5 3 0 0 3
Zip Code
Street Address Line 2
1 0 6 6 C H U R C H I L L L A N E
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
/ /
1 2 2 2 1 9 8 4
Date of Birth (mm/dd/yyyy)
9 2 6 3 5 8 0 7 2
SSN/EIN/Tax ID
Name of Trustee/Executor (if applicable)
G R E E N S T E I N E L E A N O R R U T H
Name of Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
L A
State
N E W O R L E A N S
City
7 0 1 2 4 1 9 2 0
Zip Code
Street Address Line 2
2 1 N O R T H L A K E W O O D D R I V E
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
/ /
1 0 1 1 1 9 6 0
Date of Birth (mm/dd/yyyy)
9 1 5 9 9 2 1 3 5
SSN/EIN/Tax ID
Name of Trustee/Executor (if applicable)
P A R K E T M O L L Y J A N E
Name of Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
X
3 3
DESIGNATING MULTIPLE PRIMARY BENEFICIARIES
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation Share: %
F L
State
M I R A M A R
City
3 3 0 2 8 1 2 3 4
Zip Code
Street Address Line 2
1 5 0 6 A R B O R R O A D
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
/ /
6 1 3 1 9 9 1
Date of Birth (mm/dd/yyyy)
9 0 2 3 7 6 6 3 3
SSN/EIN/Tax ID
Name of Trustee/Executor (if applicable)
A B B O T T H O W A R D K E N N E T H J R
Name of Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
3 4
X
X
–
–
–
M D
State
B E T H E S D A
City
2 0 8 1 5 0 6 3 7
Zip Code
S U I T E 2 4 0 A
Street Address Line 2
6 4 7 3 0 C O N N E C T I C U T A V E N U E
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
1 0 0
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation Share: %
/ /
Date of Birth (mm/dd/yyyy)
7 9 9 9 9 9 9 9 9
SSN/EIN/Tax ID
E L E A N O R J A R V I S
Name of Trustee/Executor (if applicable)
T H E X Y Z F O U N D A T I O N
Name of Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
N Y
State
N E W Y O R K
City
1 4 6 0 7 8 2 9 5
Zip Code
Street Address Line 2
1 1 1 1 D E L A W A R E L A N E
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
/ /
Date of Birth (mm/dd/yyyy)
SSN/EIN/Tax ID
E R I C P M A N O
Name of Trustee/Executor (if applicable)
J O H N P M A N O T R U S T
Name of Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation Share: %
C A
State
A L A M E D A
City
9 4 5 1 0 7 4 8 1
Zip Code
Street Address Line 2
1 5 0 R O S S M O Y N E D R I V E
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
/ /
Date of Birth (mm/dd/yyyy)
SSN/EIN/Tax ID
M A R L A M C C L A I N
Name of Trustee/Executor (if applicable)
E S T A T E O F R U T H R J O N A H
Name of Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation Share: %
1 0 0
1 0 0
DESIGNATING A TRUST
DESIGNATING AN ESTATE
X
X
X
DESIGNATING A LEGAL ENTITY/CORPORATION
–
–
–
Do Not Write In This Section
FORM TSP-3, Page 2 (10/2013)
PREVIOUS EDITIONS OBSOLETE
TSP Account Number:
(Last, First, Middle)
Name:
State
City
-
Zip Code
Street Address Line 2
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
/ /
Date of Birth (mm/dd/yyyy)
SSN/EIN/Tax ID
Name of Trustee/Executor (if applicable)
Name of Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation Share: %
State
City
-
Zip Code
Street Address Line 2
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
/ /
Date of Birth (mm/dd/yyyy)
SSN/EIN/Tax ID
Name of Trustee/Executor (if applicable)
Name of Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation Share: %
Check here if naming more than three primary beneficiaries
(see instructions for submitting additional pages).
Witness 1: SignatureParticipant’s Signature Date Signed
Date Signed
Witness 2: Signature
Date Signed
IV. primary BENEFICIARY DESIGNATIONS
To designate more than three primary beneficiaries, make a copy of this page.
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation Share: %
State
City
-
Zip Code
Street Address Line 2
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
/ /
Date of Birth (mm/dd/yyyy)
SSN/EIN/Tax ID
Name of Trustee/Executor (if applicable)
Name of Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
Form TSP-3 (10/2013)
PREVIOUS EDITIONS OBSOLETE
FORM TSP-3, INFORMATION AND INSTRUCTIONS FOR PAGE 3
SECTION V — Contingent Beneficiary Designations. Do not com-
plete this page if you are not naming contingent beneficiaries. You
may designate one or more contingent beneficiaries for each prima-
ry beneficiary you name on Page 2. The contingent beneficiary(ies)
you name will share the portion of the TSP account that you des-
ignated for a specific primary beneficiary who dies before you do.
For example, Joe Brown is one of your two primary beneficiaries,
and his share is 30% of your account. If you designate Mary Brown
and Sue Brown (Joe‘s daughters) as his contingent beneficiaries,
and each is to get 50%, each would get 50% of Joe‘s portion. Since
Joe’s share is 30% of your account, each will get 15% of your ac-
count. (You cannot designate contingent beneficiaries for contingent
beneficiaries. In this case, you cannot designate contingent benefi-
ciaries for Mary or Sue Brown.) For another example of this situa-
tion, see Example 2 below.
Check the box that indicates the contingent beneficiary’s relation-
ship to you. If you are only naming one contingent beneficiary for a
primary beneficiary, the share for that contingent beneficiary must
be 100%. If you name more than one contingent beneficiary for a
primary beneficiary, the combined share values for those contingent
beneficiaries must equal 100%.
Provide the identifying information for contingent beneficiaries ac-
cording to the instructions for designating primary beneficiaries
in Section IV. For each contingent beneficiary you designate, enter
the full name, share, address, and Social Security number (SSN) or
other tax ID (such as Employer Identification Number (EIN)). If you
do not have all the requested information, you must provide at least
the contingent beneficiary’s name and share. You must also provide
the primary beneficiary’s name and tax ID information (e.g., SSN or
EIN, if available) or date of birth.
If you want to name the same contingent beneficiary for multiple
primary beneficiaries, you should list your contingent beneficiary
multiple times in order to link it to each primary beneficiary.
If you are naming more than 3 contingent beneficiaries, photocopy
Page 3 of this form. Enter your name and TSP account number on
the top of each page and follow the instructions for completing Sec-
tion V. You must sign and date all additional pages; the same two
witnesses who signed Page 1 must also sign and date all pages,
including any extra pages, that you submit to the TSP.
Note: If a named beneficiary dies, you may prefer to submit another
Form TSP-3 to change your designation(s).
EXAMPLES. Below are examples of how to designate contingent
beneficiaries.
EXAMPLES OF DESIGNATING CONTINGENT BENEFICIARIES
A Z
State
T U C S O N
City
8 5 7 3 5 3 0 0 3
Zip Code
1 0 6 6 C H U R C H I L L L A N E
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
1 0 0
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation Share: %
/ /
3 1 8 2 0 0 3
Date of Birth (mm/dd/yyyy)
9 7 4 0 2 3 9
4 1
SSN/EIN/Tax ID
Name of Trustee/Executor (if applicable)
G R E E N S T E I N A M Y J O A N
Name of Contingent: Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
G R E E N S T E I N E L E A N O R R U T H
Primary Beneficiary’s Name (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
9 2 6 3 5 8 0 7 2
SSN/EIN/Tax ID or Date of Birth
Contingent to which primary beneficiary?
EXAMPLE 1
In the above example, if the primary beneficiary, Eleanor Ruth Greenstein, dies
before you do, Amy Joan Greenstein would receive 100% of her share. Thus, if
Eleanor’s share is 33% of your account, Amy would receive all of Eleanor’s share.
X
–
C A
State
R O C K L A W N
City
9 4 5 1 0 9 8 7 6
Zip Code
1 4 9 2 M A R I G O L D A V E N U E
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation Share: %
/ /
5 2 6 1 9 5 5
Date of Birth (mm/dd/yyyy)
9 9 9 8 8 7 7 7 7
SSN/EIN/Tax ID
Name of Trustee/Executor (if applicable)
H A L T R I C H A R D A L A N
Name of Contingent: Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
P A R K E T M O L L Y J A N E
Primary Beneficiary’s Name (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
9 1 5 9 9 2 1 3 5
SSN/EIN/Tax ID or Date of Birth
Contingent to which primary beneficiary?
5 0
C A
State
R O C K L A W N
City
9 4 5 1 0 9 8 7 7
Zip Code
2 0 0 7 I R I S C O U R T
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
5 0
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation Share: %
/ /
1 2 6 1 9 6 2
Date of Birth (mm/dd/yyyy)
9 4 2 2 6 7 8 9 2
SSN/EIN/Tax ID
Name of Trustee/Executor (if applicable)
H A L T M E L I S S A E L A I N E
Name of Contingent: Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
P A R K E T M O L L Y J A N E
Primary Beneficiary’s Name (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
9 1 5 9 9 2 1 3 5
SSN/EIN/Tax ID or Date of Birth
Contingent to which primary beneficiary?
In the above example, if the primary beneficiary, Molly Jane Parket, dies before
you do, Richard Alan Halt and Melissa Elaine Halt would each receive 50% of
her share. In other words, if Molly Jane Parket’s share is 33% of your account
balance, they would each get 50% of what Molly would have received — not 50%
of your account.
X
X
EXAMPLE 2
–
–
I L
State
C H I C A G O
City
6 0 6 0 1 1 7 4 8
Zip Code
6 5 4 3 A R K A N S A S D R I V E
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation Share: %
/ /
1 1 3 0 1 9 8 3
Date of Birth (mm/dd/yyyy)
9 7 1 0 8 6 2 3 4
SSN/EIN/Tax ID
Name of Trustee/Executor (if applicable)
R O B S O N J A N I C E M A R I A
Name of Contingent: Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
J E R O M E W H E E L I S T R U S T
Primary Beneficiary’s Name (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
Contingent to which primary beneficiary?
1 0 0
In the above example, if the primary beneficiary, the Jerome Wheelis Trust, is
terminated before your death, Janice Maria Robson would receive the entire share
that you designated for the Jerome Wheelis Trust.
X
EXAMPLE 4
SSN/EIN/Tax ID or Date of Birth
–
I D
State
B O I S E
City
8 3 7 0 9 2 1 4 3
Zip Code
9 2 O A K S T R E E T
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
1 0 0
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation Share: %
/ /
Date of Birth (mm/dd/yyyy)
SSN/EIN/Tax ID
T I M O T H Y R E E L S
Name of Trustee/Executor (if applicable)
E S T A T E O F B E T S Y A L U C A S
Name of Contingent: Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
Z A C H A R I A S I D N E Y S T E V E N
Primary Beneficiary’s Name (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
Contingent to which primary beneficiary?
In the above example, if the primary beneficiary, Sidney Steven Zacharia, dies
before you do, the estate of Betsy A. Lucas would receive 100% of the amount you
designated for Sidney Steven Zacharia.
X
EXAMPLE 3
9 0 3 2 4 7 6 5 2
SSN/EIN/Tax ID or Date of Birth
–
TSP Account Number:
(Last, First, Middle)
Name:
FORM TSP-3, Page 3 (10/2013)
PREVIOUS EDITIONS OBSOLETE
Do Not Write In This Section
TSP Account Number:
(Last, First, Middle)
Name:
V. contingent BENEFICIARY DESIGNATIONS
To designate more than three contingent beneficiaries, make a copy of this page.
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation %
Witness 1: SignatureParticipant’s Signature Date Signed
Date Signed
Witness 2: Signature
Date Signed
Check here if naming more than three contingent benefi-
ciaries (see instructions for submitting additional pages).
State
City
-
Zip Code
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
/ /
Date of Birth (mm/dd/yyyy)
SSN/EIN/Tax ID
Name of Trustee/Executor (if applicable)
Name of Contingent: Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
Name (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
SSN/EIN/Tax ID or Date of Birth
Contingent to which primary beneficiary?
SHARE of
Primary’s
Portion:
State
City
-
Zip Code
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation %
/ /
Date of Birth (mm/dd/yyyy)
SSN/EIN/Tax ID
Name of Trustee/Executor (if applicable)
Name of Contingent: Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
Name (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
SSN/EIN/Tax ID or Date of Birth
Contingent to which primary beneficiary?
SHARE of
Primary’s
Portion:
State
City
-
Zip Code
Street Address or Box Number (For a foreign address, see Information and Instructions for Page 1.)
Foreign address?
Check here.
Relationship to you: Spouse Other Individual Trust Estate Legal Entity/Corporation %
/ /
Date of Birth (mm/dd/yyyy)
SSN/EIN/Tax ID
Name of Trustee/Executor (if applicable)
Name of Contingent: Individual (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
Name (Last, First, Middle)/Trust/Estate/Legal Entity or Corporation
SSN/EIN/Tax ID or Date of Birth
Contingent to which primary beneficiary?
SHARE of
Primary’s
Portion:
FORM TSP-3 (10/2013)
PREVIOUS EDITIONS OBSOLETE
Check to make sure that:
You have provided your name and account number on each page that you
submit to the TSP.
You have signed all pages you completed (including any extra pages you may
have added) on the same date.
You have had the same two witnesses sign and date all pages — including any
extra pages — after you have signed and dated the form.
You have not altered this form or any information you provided on it.
Your primary beneficiaries’ shares add up to 100%.
If you named contingent beneficiaries, you named a primary beneficiary for
each contingent beneficiary.
If you named contingent beneficiaries, the shares for all contingent
beneficiaries for each primary beneficiary add up to 100%.
You have kept a copy of your completed form (and any pages you may
have added) for your records.
You have addressed this form to:
Thrift Savings Plan
P.O. Box 385021
Birmingham, AL 35238
