Transcription of Application for Service Retirement (VRS-5)
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Application for Service Retirement (VRS-5)
VRS-5 (Rev. 01/16) *VRS-000005* Application FOR Service Retirement PART A. MEMBER INFORMATION 3. Name (First, Middle Initial, Last) 4. Address (Street, City, State and Zip+4) 5. Are you a Virginia resident? Yes No 6. Are you a citizen? Yes No 7. Marital Status Never Married Married or Separated Widowed Divorced Date of Divorce (mm/dd/yyyy) 8. Home Phone Number 9. Daytime Phone Number 10. Birth Date (mm/dd/yy) 11. Retirement Date (mm/01/yy) 12. Do you intend to make a lump-sum purchase of Service credit prior to Retirement ? Yes No 13. Will you be purchasing Service credit with a sick leave payment?
VRS-5 (Rev. 01/16) INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR SERVICE RETIREMENT Please read the service retirement information in your Handbook for Members before completing your application. You may obtain this handbook from your benefits administrator or view it on the VRS Web site (www.varetire.org).
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