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New York City Employees' Retirement System
Trusted Partner of NYC Employees for More Than 90 Years
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WTC
Executive Director Update
WTC Legislation
WTC FAQs
NYCERS Notice of Participation - F622
Filing Deadline: 9/11/2018
NYCERS Agency Report - F623
Disability Applications
Additional Resources
Join NYCERS
Member Resources
Planning for Retirement
Pension Seminars
Videos
Translation Services
FAQs
Glossary
Updates & Alerts
Forms and Publications
Forms, Brochures and Fact Sheets
Summary Plan Descriptions
CAFR
Legislation
About
Career Opportunities
Board of Trustees
Contact
Customer Service Center
Call Center
Mailing Address
Executive Offices
Fax Numbers
Inspector General
Report of Death
Step 1 - Please provide information about yourself
We require information about you, the person reporting the death, so that we can contact you if we have questions in the course of processing a claim for benefits.
*
Your Name:
Relationship to Deceased:
*
Address:
Apt #:
*
City:
*
State/Territory:
(Select Other Country if outside U.S.)
Select One
New York
Puerto Rico
Virgin Islands
----------------
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
----------------
Puerto Rico
Virgin Islands
----------------
Other country
*
Country:
*
Zip/Postal Code:
*
Daytime Telephone #:
(Ex: xxx xxx xxxx or xxxxxxxxxx)
*
Are you the Executor of the Estate ?
Yes
No
*
Do you know who the Executor is ?
Yes
No
Please provide information about Executor of Estate.
*
Executor of Estate Name:
Executor of Estate Address:
Apt #:
City:
State/Territory:
(Select Other Country if outside U.S.)
Select One
New York
Puerto Rico
Virgin Islands
----------------
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
----------------
Puerto Rico
Virgin Islands
----------------
Other country
Country:
Zip/Postal Code:
Telephone #:
*
= Required Fields