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Employer Code Clear Form Use this form to designate additional beneficiaries when the number of beneficiaries you desire exceeds the number allowed on the Designation of Beneficiary (VRS-2). Complete this form at the same time you complete the VRS-2. This form may only be used at the time a VRS-2 is completed; you cannot submit a VRS-2A to add to a VRS-2 that is already on file with VRS. 3. Name 4. Birth Date (First, Middle Initial, Last) PART B. VRS BASIC AND OPTIONAL LIFE INSURANCE.
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