Forms

Forms 1. Mississippi Department of Public Safety requires the following Benefits Trust forms to qualify for payment of benefits under the Other Safety Officials Death Benefits Trust Fund: a. Beneficiary Designation Form (Form OS-010) - To be completed by "Covered Individuals" as defined by the statute, upon employment or during the Covered Individual’s lifetime, for purposes of naming a beneficiary or beneficiaries for receiving death benefits payments; and, b. Other Safety Officials Death Benefits Claim Application (Form OS-020) - To be completed by the "Employer", as defined by the statute, and submitted to the Mississippi Department of Public Safety on behalf of a Covered Individual and his/her beneficiaries.