TIAA Annuity No.
CREF Annuity No.
TIAA Policy No.
My Name has been changed to that given below and I authorize you to use the new name hereafter:
(Print New Name Here)
PRINT FORMER NAME HERE
My Name has been changed by: (Check appropriate box below)
Date
Name and Address of Court
Marriage
Divorce
Adoption*
Court Order*
Other Means* (Please Explain)
*Note: A certified copy of any Court Order or other document authorizing the change should be furnished.
Former Signature
Sign as Follows:
New Signature ________________________________________________________________________________
Sign as Follows:
Address to which
mail shall be sent ______________________________________________________________________________________
FOR TIAA-CREF USE ONLY
Accepted – Teachers Insurance and Annuity Association
College Retirement Equities Fund
F82 (5/05)
P. O. Box 1259
Charlotte, NC 28201
NOTICE OF CHANGE OF NAME